Nasopharyngeal carcinoma in children

87

Abstracts Experience of endoscopic treatment of tracheal granulation by KTP laser incision Yayoi Takata, Mitsuhito Sano Department qf Otorhinolaryngology, nul and Children’s Health. Osaku

Osaka Medical Center and Research Institute ,for Mater-

Four cases are presented where, after prolonged indwelling cannula followed by tracheostomy, severe tracheal granulation developed. It is very difficult with forceps to remove tracheal granulation perfectly and safely. It is mentioned as a merit of laser surgery, that hemorrhage during and after operation is very slight. The operation was performed by endoscopic KTP laser. We used the KTP laser to vaporise the granulation until a lumen was established down to the trdcheostomy site under general anaesthesia. After KTP laser surgery we fixed a cannula over the cauterized region and sedated to evade bronchospasm with artificial respirator for from 4 to 12 days at ICU. KTP laser is a good application when the granulation is too hard to cut by forceps and where granulation exists in the very narrow trachea of children. A case of intractable juvenile laryngo-trachealpapillomatosis Yasue Uchida, Kayao Kuno, Tsutomu Nakashima, Noriyuki Depptrrtmerzt of‘ Otorllinolar),ngol~)g)~. Nugoya Unioersit~~

Yanagita

A case of intractable juvenile laryngo-tracheal papillomatosis is reported. A l-year-old girl with hoarseness was referred to our hospital in May, 1995. After tracheostomy, she was treated by local injection of interferon (IFN) combined with laser surgery. The recurrent growth of tracheal papillomas was rapid and widespread, so surgical removal was needed to maintain an airway. Surgical treatment was repeated 45 times for I year and 7 months without any success. Even with additional systemic administration of IFN therapy, it was hard to control the papillomatosis. Human papillomavirus (HPV) type 6 was detected in this case. We presented this case to listen to some other opinions for more effective therapy. Nasopharyngeal

carcinoma in children

Jun Okamura Sectiorl of‘ Pediatrics, Nationcd Kyushu Cancer Center, Fukwka.

Japan

Nasopharyngeal carcinoma (NPC) is an extremely uncommon cancer among children. Incidence is probably less than 10 cases per year according to the cancer registry for Japanese children. Therefore, it is rare to find a report on a treatment result for children with NPC in the Japanese literature. We have seen four children with NPC during the last IO-year period: two boys and two girls. Their mean age was 14. All four cases had cervical lymphadenopathy at diagnosis and stages were IV in all cases according to the American Joint Committee for NPC. Histological examination of the tumor showed undifferentiated carcinoma (WHO type 3) in all cases. In situ hybridization using EBER-1 prove indicated that all four tumors were positive for Epstein Barr virus (EBV) genome. EBV titers (VCA-IgG, EA-DR-IgG, or EBNA) were high in four cases. Garium scan was also positive in all cases. All cases were treated by the protocol for NPC at our department: FAR regimen and multiagent chemotherapy. FAR regimen was consisted with daily doses of 5 Fu 250 mg (i.v.). Vitamin

88

Abstracts

A 50 000 units (i.m.) and irradiation 150 cGy to the tumor (total doses were 70 Gy to nasopharyngeal mass and 40 Gy to the neck nodes). After completion of FAR regimen, patients were given combination chemotherapy with vincristine (VCR) 1.4 mg/m2 (day l), adriamycin (ADM) 40 mg/m2 (day 1) and cyclophosphamide (CPM) 200 mg/m2 (days 2-5) every- 4 weeks (Gasparini, 1988). ADM was discontinued after nine doses and additional three cycles of VCR + CPM were administered. In addition, three of four cases received hyperthermia therapy (425°C for 60 min) to the residual neck tumors. All four patients completed the scheduled treatment. As of December, 1996, all are alive and disease-free at 27, 94, 97 and 116 months after diagnosis. They fully attend social activities without late sequelae of the treatment. Although the number of cases is small, the regimen seems to be quite effective for childhood NPC even in advanced stages. Since the number of cases with NPC are so limited in children, we need to develop multi-institutional studies to prove the effectiveness of the protocol for NPC. The Japan Society for Pediatric Otorhinolaryngology President:

Secretary:

Treasurer: Journal Editor:

Keijiro Koga, M.D., Department of Otolaryngology, Faculty of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160, Japan J-l Suzuki, M.D., Department of Otolaryngology, Faculty of Medicine, Teikyo University 2-l 1-l Kaga, Itabashi-ku, Tokyo 173, Japan Nobuko Kawashiro, M.D., Department of Otolaryngology, National Children’s Hospital, 3-35-31 Taishido, Setagaya-ku, Tokyo 154, Japan Yuki Iino, M.D., Department of Otolaryngology, Faculty of Medicine, Teikyo University, 2-l 1-l Kaga, Itabashi-ku, Tokyo 173, Japan. Fax: + 8 1 3 3964 0659

Correspondence: Kimitaka Kaga, M.D., Department of Otolaryngology, Faculty of Medicine, University of Tokyo, 7-3-l Hongo, Bunkyo-ku, Tokyo 113, Japan. Tel: + 81 3 3812 8058; Fax: + 81 3 3814 9486