Introduction
Nasopharyngeal carcinoma (NPC) is a very rare tumor in children. Although enormous differences exist among races and geographical groups, nasopharyngeal carcinoma makes up 1–5% of all pediatric cancers and 20–50% of all primary malignant nasopharyngeal tumors in children. This disease has been linked to etiological factors such as Epstein Barr virus, consumption of food rich in nitrosamines, and genetic and epigenetic factors that are still unclear. Current treatment protocols use induction with Cisplatin-based chemotherapy and 5-FU with concomitant chemoradiotherapy. Prognosis with current protocols treating pediatric nasopharyngeal carcinoma is excellent with an overall survival higher than 85% [1].
5-FU is a known inducer of cardiotoxicity in adult patients, particularly those with underlying cardiovascular disease. The cardiotoxic effects of 5-FU in the pediatric population are not well described. Previous studies of adults with 5-FU-mediated cardiotoxicity described events of myocardial infarction, coronary vasospasm, arrhythmias or cardiomyopathy [2]. The mechanism is not fully understood; however, may be due to a combination of ischemia related to coronary vasospasm and direct myocardial cell toxicity [3]. Uridine triacetate was FDA approved in December of 2015 as a 5-FU reversal agent for the emergency treatment of patients with life-threatening toxicity.