Treatment, Outcomes, and Late Effects in Adolescent and Young Adult Nasopharyngeal Carcinoma in a Provincial Population.
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PURPOSE: Nasopharyngeal carcinoma (NPC) is a rare cancer, especially in nonendemic regions such as North America, occurring in a bimodal age distribution with the first peak in adolescents and young adults (AYA). Limited data exist on treatment outcomes in this group. The purpose of our study is to evaluate treatment outcomes of NPC in the AYA population in British Columbia, Canada, and evaluate late effects. METHODS: We conducted a retrospective cohort study of AYA patients (ages of 15-39 years at diagnosis) diagnosed with NPC and treated between 2000 and 2015. Demographics, treatment outcomes, and late toxicities were collected. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier and Cox regression. Locoregional recurrence and distant metastatic recurrence were evaluated using the competing risk method. Late effects were described qualitatively and quantitatively. RESULTS: The cohort included 97 patients: 93 received curative intent treatment, 3 received palliative treatment, and 1 was excluded from survival analysis. Five-year OS rates were 81% (Stage I/II), 80% (Stage III), and 68% (Stage IV), with corresponding DFS rates of 78%, 77%, and 66%. The addition of neoadjuvant and/or adjuvant chemotherapy to radiotherapy was associated with improved survival. Advanced-stage disease had a higher incidence of locoregional relapse. Common late toxicities included xerostomia, hearing loss, epistaxis, and hypothyroidism. CONCLUSION: Although survival rates in our cohort were comparable to existing literature, the rate of late toxicities was high. These findings support the need for AYA-tailored treatment strategies and survivorship care to minimize long-term complications and optimize quality of life.