Text Box: MALIGNANT TUMOURS IN THE HEAD AND NECK REGION IN CHILDHOOD: GOOD OUTCOME WITH CURRENT THERAPEUTIC APPROACH 
Chan GCF1, Chan KL2, Kwong DLW3, Chiang AKS1, Lee TL1, Ha SY1, Tam PKH2, Lau YL1
Departments of Paediatrics1, Surgery2 & Clinical Oncology3, Queen Mary Hospital, University of Hong Kong

Objectives:  Types of malignant tumours found in the head and neck region (H&N tumours) in childhood and their therapeutic approaches differ significantly from that of adult, but there are very few data about these aspects in the literature. 
Methods: Retrospective review (July 1990 to June 2000) of children (<18 yrs) with H&N tumours [including Langerhan¡¯s Cell Histiocytosis (LCH)], excluding brain tumours were performed. 
Results: Within this 10 years period, 392 children with malignant disease attended our service. There were 26 (6.7%) children with primarily H&N tumours. The M: F ratio was 14:12 and the median age was 4.5 years (0-16 yrs). The disease types were namely: non-Hodgkin¡¯s lymphoma (NHL) n=7, LCH n=6, retinoblastoma (RB) n=4, rhabdomyosarcoma (RMS) n=4, Ewing¡¯s family sarcoma (EWS/pPNET) n=3, neuroblastoma n=1, thyroid carcinoma (ThyCA) n=1.  Surgery or radiation therapy (RT) alone was the treatment of choice for children with RB (all with localized disease). Children with NHL & 5/6 LCH were treated with chemotherapy alone. NB, RMS, EWS and pPNET required multi-modality approach and despite good initial response with chemotherapy in all patients, late relapse remains a problem.  The overall 4 years event free survival (EFS) was 83% and the median follow up period was 4 years. Children with LCH, NHL & RB (all with 100% EFS) had significantly better outcome than those with EWS/pPNET (EFS 50% at 4 yrs) or RMS (EFS 50% at 2 yrs) (p=0.002).
Conclusions: Despite the difficulty in completely resecting the H&N tumours in children, the overall outcome is satisfactory. Children with NHL and multi-focal LCH responded well to chemotherapy and this should be the primary form of treatment. 
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