Nasopharyngeal carcinoma in a non-endemic country—Validation of the new NPC staging system

Background: Nasopharyngeal carcinoma (NPC) staging has recently been updated, with the eighth edition of the AJCC/UICC. In the last ten years, Intensity Modulated Radiotherapy (IMRT) has become a standard treatment for NPC. The authors aim to assess the benefits of the new AJCC staging system in predicting prognosis, as well as the improvement in survival outcomes in the IMRT era, in non-edemic population.MethodsRetrospective study selecting patients treated for NPC between January 2009 and December 2019 in a cancer treatment center in Portugal. Initial TNM staging (according to the seventh edition of the AJCC/UICC) was collected and each patient was restaged according to the new TNM staging system. Overall survival (OS) and Distant Metastasis Free Survival (DMFS) stratified by T and N classification and stage (according to the both TNM staging systems) were analyzed. Univariate and multivariate analysis was performed to evaluate which factors influence OS and DMFS. Data in this series was compared with a previous report from the same institution, before IMRT standard use.Results113 patients were included, averaging 53.74 (±1.4) years old. With the new TNM staging, 5 patients were downstaged and 3 patients were upstaged. Over a median follow-up time of 41 months, the 5-year OS and DMFS were 77% and 79.8%, respectively. Neither the seventh nor the eighth editions of the AJCC/UICC staging system had good overall discrimination between each T classification OS and DMFS curves. Both the seventh and the eighth editions of the AJCC/UICC staging system had statistically significant overall discrimination between each N group and each stage group classification OS curves. Only N classification predicted OS in multivariate analysis. When comparing to a previous report from the same institution, OS has not improved majorly, especially in locoregionally advanced disease.ConclusionsTNM staging still presents limitations in adequately predicting OS and DMFS. (AU)

Antecedentes: La estadificación del carcinoma nasofaríngeo (NPC, por sus siglas en inglés) se ha actualizado recientemente, con la octava edición del AJCC/UICC. En los últimos 10 años, la radioterapia de intensidad modulada (IMRT, por sus siglas en inglés) se ha convertido en un tratamiento estándar para la NPC. Los autores pretenden evaluar los beneficios del nuevo sistema de estadificación del AJCC en la predicción del pronóstico, así como la mejora en los resultados de supervivencia en la era de la IMRT, en una población non endémica.MétodosEstudio retrospectivo de selección de pacientes tratados por NPC entre enero de 2009 y diciembre de 2019 en un centro de tratamiento del cáncer en Portugal. Se recopiló la estadificación TNM inicial (según la séptima edición del AJCC/UICC) y se reestadificó cada paciente de acuerdo con el nuevo sistema de estadificación TNM. Se analizaron la supervivencia global (SG) y la supervivencia libre de metástasis a distancia (SLMD) estratificadas por clasificación T y N y estadio (según ambos sistemas de estadificación TNM). Se realizó un análisis univariante y multivariante para evaluar qué factores influyen en la SG y la SLMD. Los datos de esta serie se compararon con un informe anterior de la misma institución, antes del uso estándar de la IMRT.ResultadosSe incluyeron 113 pacientes, con una edad promedio de 53,74 (±1,4) años. Con la nueva estadificación TNM, 5 pacientes aumentaron estadio y 3 pacientes disminuyeron estadio. Durante una mediana de tiempo de seguimiento de 41 meses, la SG y la SLMD a 5 años fueron del 77 y del 79,8%, respectivamente. (AU)

SEOM-TTCC clinical guideline in nasopharynx cancer (2021)

Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiotherapy (RT) is the cornerstone of locoregional treatment of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time.

Use of nimotuzumab combined with cisplatin in treatment of nasopharyngeal carcinoma and its effect on expressions of VEGF and MMP-2

Purpose This paper aims to observe the expressions of VEGF and MMP-2 in patients with nasopharyngeal carcinoma treated by nimotuzumab combined with cisplatin. Methods Altogether, 104 patients with nasopharyngeal carcinoma treated in our hospital from April 2014 to August 2016 were selected as research subjects. Among them, 50 patients treated with cisplatin were divided into a control group and 54 patients treated with nimotuzumab combined with cisplatin were divided into an observation group. The two groups of patients were compared in terms of efficacy after treatment and incidence of adverse reactions. Changes of serum VEGF and MMP-2 concentrations before and after treatment were detected using enzyme-linked immunosorbent assay (ELISA), and the 3-year overall survival (OS) of patients was observed. Results Compared with the control group, patients in the observation group had significantly higher total remission rate (RR) (P < 0.05) and significantly lower incidence of adverse reactions (P < 0.05). Before treatment, there was no significant difference between the observation and control groups in the concentrations of VEGF and MMP-2 (P > 0.05). After treatment, the concentrations in the two groups were significantly lower than those before treatment (P < 0.05), and the concentrations in the observation group were significantly lower than those in the control group (P < 0.05). There was no significant difference in the 3-year OS between the observation and control groups (P > 0.05). Conclusions Nimotuzumab combined with cisplatin could improve the conditions of patients with nasopharyngeal carcinoma. After treatment, the expression of VEGF and MMP-2 decreased significantly. We speculated that it improves the survival rate of patients by reducing the expression of VEGF and MMP-2 (AU)

Linfoma difuso de células grandes B asociado a metotrexato en un paciente afecto de una leucemia linfoblástica aguda / Diffuse large B cell lymphoma associated with methotrexate in a patient with acute lymphoblastic leukemia

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Tratamiento quirúrgico del angiofibroma nasofaríngeo juvenil en pacientes pediátricos / Juvenile nasopharyngeal angiofibroma surgical treatment in paediatric patients

Introducción y objetivos: El nasoangiofibroma juvenil es una neoplasia benigna sumamente vascularizada de tratamiento complejo, tanto en su preparación quirúrgica como en la cirugía a realizar, los riesgos y las recurrencias. El objetivo es analizar el manejo y tratamiento quirúrgico para el nasoangiofibroma juvenil. Materiales y métodos: Se revisaron las historias clínicas e imágenes de los pacientes intervenidos por la especialidad de cirugía de cabeza, cuello y maxilofacial con resultado de proceso patológico compatible con nasoangiofibroma juvenil, en el periodo comprendido entre enero de 2008 a diciembre de 2016. Resultados: Se intervinieron 61 casos, todos ellos tratados con el mismo acceso quirúrgico por medio de una osteotomía Le Fort I. La totalidad de los pacientes fue de sexo masculino, con un promedio de edad de 13,3 años. Se utilizó la clasificación de Andrew-Fish para la estadificación de los casos, obteniendo los grados ii y i la mayor cantidad de casos. Conclusiones: El abordaje descrito provee un acceso quirúrgico extenso, el cual es adecuado para los diferentes estadios de la tumoración. Requiere de experiencia para poder llevar a cabo la resección de la tumoración con el menor sangrado posible

Introduction and objectives: The juvenile nasopharyngeal angiofibroma is a highly vascularised benign neoplasm of complex treatment in its surgical preparation, surgery to be performed, risks and recurrences. The aim of the study was to analyze the management and surgical treatment for the pathology of juvenile nasoangiofibroma. Materials and methods: We reviewed the clinical histories and images of the patients who underwent surgery with a pathology result of juvenile nasoangiofibroma in the period from January 2008 to December 2016. Results: Sixty-one cases were treated; all of them treated using the same surgical access by means of a Le Fort I osteotomy. All of the patients were male, with an average age of 13.3 years. The Andrew-Fish classification was used for staging the cases, most were staged as grade II and I. Conclusions: The described approach provided extensive surgical access, which was adequate for the different stages of the tumour. It requires experience to be able to resect the tumour with the least possible bleeding

Adenocarcinoma papilar de nasofaringe de bajo grado "thyroid-like". Caso clínico y revisión de la literatura / Low-grade papillary adenocarcinoma of nasopharynx. Case report and review of the literatura

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Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe / Salvage surgery in the treatment of local recurrences of nasopharyngeal carcinomas

INTRODUCCIÓN Y OBJETIVOS: La quimiorradioterapia es el tratamiento de elección del carcinoma de nasofaringe. Las recurrencias locales son una de las principales causas de mortalidad en estos pacientes: el rescate quirúrgico o la reirradiación son el tratamiento de elección, según la disponibilidad. El objetivo fue evaluar y comparar los resultados de la cirugía de rescate en el tratamiento de las recidivas locales de los carcinomas nasofaríngeos mediante abordajes abiertos vs. endoscópicos. MÉTODOS: Veinte pacientes con recidivas locales de carcinomas nasofaríngeos fueron intervenidos quirúrgicamente: 12 pacientes fueron intervenidos mediante cirugía abierta y 8 mediante un abordaje endoscópico endonasal transpterigoideo. Un paciente fue estadiado como rT1; 3 como rT2; 2 como rT3 y 6 como rT4 en el grupo de abordajes abiertos; en la serie endoscópica, 2 pacientes fueron rT1, 5 fueron rT2 y uno fue rT3. RESULTADOS: En 3 de los pacientes (25%) intervenidos mediante cirugía abierta (un rT4, un rT3 y un rT2) no se logró una resección macroscópica completa). En el grupo endoscópico la resección fue completa en todos los pacientes. La tasa de complicaciones en el grupo intervenido mediante abordajes abiertos fue del 92% (5 complicaciones leves, 5 complicaciones moderadas y una complicación grave) y en el grupo intervenido mediante endoscopia fue del 100% (7 sufrieron complicaciones leves y un paciente una complicación grave). La supervivencia a los 3 y 5 años fue del 53 y del 42% en el abordaje abierto y del 100 y del 75% en el abordaje endoscópico, respectivamente. CONCLUSIONES: Los abordajes endoscópicos disminuyen la morbilidad asociada a los abordajes abiertos y permiten obtener un control oncológico favorable

INTRODUCTION AND OBJECTIVES: Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches. METHODS: Twenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1; 3 as rT2;2 as rT3; and 6 as rT4 in the group of open approaches; in the endoscopic series, 2 patients were rT1, 5 rT2 and one rT3. RESULTS: In 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (5 minor complications, 5 moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (7 had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively. CONCLUSIONS: Endoscopic approaches decrease the morbidity associated with open approaches and allow for favourable oncological control

SEOM clinical guideline in nasopharynx cancer (2017)

Nasopharyngeal carcinoma (NPC) is distinct from other cancers of the head and neck in biology, epidemiology, histology, natural history, and response to treatment. Radiation therapy is an essential component of curative-intent of non-disseminated disease and the association of chemotherapy improves the rates of survival. In the case of metastatic disease stages, treatment requires platinum/gemcitabine-based chemotherapy and patients may achieve a long survival time (AU)

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Carcinoma nasofaríngeo familiar en zona no endémica. Presentación de 3 familias / Familial clustering of nasopharyngeal carcinoma in non-endemic area. Report of three families

El carcinoma nasofaríngeo es el tumor más frecuente que surge en la nasofaringe. Su etología es multifactorial, considerándose como factores de riesgo la distribución racial y geográfica, la infección por el virus de Epstein-Barr (VEB), así como la exposición ambiental a determinas sustancias. Esta afección es endémica en algunas zonas asiáticas, donde se han encontrado predisposición genética en su oncogénesis. Existe una fuerte susceptibilidad entre el carcinoma de nasofaríngeo y el HLA, donde se han encontrado haplotipos relacionados específicos. En zonas donde la incidencia es baja, existen pocos casos publicados sobre familias afectadas. Reportamos 3 casos de familias con carcinoma de nasofaringe entre hermanos, en población no asiática, probablemente relacionada con la infección por el VEB (AU)

Nasopharyngeal carcinoma is the predominant tumour type arising in the nasopharynx. Its aetiology is multifactorial; racial and geographical distribution, EBV infection and environmental exposure to specific substances are considered risk factors. This condition is endemic in some Asian areas, where a genetic predisposition in its oncogenesis has been established. There is a strong susceptibility between nasopharyngeal carcinoma and HLA, where related specific haplotypes have been found. In areas where the incidence is low, there are few reported cases of families affected. We report 3 cases of families with nasopharyngeal carcinoma among siblings, in the non-Asian population, probably related to EBV infection (AU)

Nasopharyngeal carcinoma: 30-year experience of a single institution in a non-endemic area

Purpose. Over the past years, radiotherapy techniques have changed significantly. The impact of these changes in the management of nasopharyngeal carcinoma (NPC) has not been fully evaluated. Methods/patients. Between 1984 and 2014, 223 NPC were diagnosed in our hospital. Prior to 2000, patients were treated with 2D treatment plan (RT2D) that evolved to 3D schemes thereafter (RT3D). Results. Tumors in the RT3D period showed significantly lower stages than those in the RT2D period. 5-year cause-specific survival improved from 55.7% (95% CI: 46.7-64.7%) in the RT2D period to 78.7% (95% CI: 68.7-88.7%) in the RT3D period (P = 0.006). This difference was greater for non-keratinizing NPC, where specific survival went from 63.2% (95% CI: 52.2-74.2%) to 84.4% (95% CI: 74.4-94.4%) (P = 0.014). Conclusion. Recent changes in treatment strategies including concurrent chemoradiation and 3D radiotherapy may have impacted in better survival for NPC. Improved imaging techniques may have contributed by earlier detection and better treatment planning (AU)

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Effect of adaptive replanning in patients with locally advanced nasopharyngeal carcinoma treated by intensity-modulated radiotherapy: a propensity score matched analysis

Purpose. Limited data have been published regarding the effect of adaptive radiotherapy (ART) on clinical outcome in patients with nasopharyngeal carcinoma (NPC). We compared the long-term outcomes in patients with locally advanced NPC treated by adaptive intensity-modulated radiotherapy (IMRT) replanning versus IMRT. Methods. 200 NPC patients with stage T3/T4 were included between October 2004 and November 2010. Patients in both treatment groups were matched using propensity score matching method at the ratio of 1:1. Clinical outcomes were analyzed with Kaplan-Meier method, log-rank test and Cox regression. Results. After matching, 132 patients (66 patients in each group) were included for analysis. The median follow-up for the IMRT replanning group was 70 months, while the IMRT group was 69 months. The 5-year local-regional recurrence-free survival (LRFS) rate was higher in IMRT replanning group (96.7 vs. 88.1 %, P = 0.022). No significant differences in distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS) were observed between the two groups. 21.2 % patients in IMRT replanning group and 28.8 % patients in IMRT group had distant metastasis. In multivariable analysis, IMRT replanning was identified as an independent prognostic factor for LRFS (hazard ratio 0.229; 95 % CI 0.062-0.854; P = 0.028), but not for DMFS, PFS and OS. Conclusions. IMRT replanning provides an improved LRFS for stage T3/T4 NPC patients compared with IMRT. Distant metastasis remains the main pattern of treatment failure. No significant advantage was observed in DMFS, PFS and OS when adaptive replanning was used (AU)

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Oncocitoma nasofaríngeo como causa de disfunción tubárica / Nasopharyngeal oncocytoma as a cause of Eustachian tube dysfunction

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Downregulated ECRG4 is correlated with lymph node metastasis and predicts poor outcome for nasopharyngeal carcinoma patients

Objective. Esophageal cancer-related gene 4 (ECRG4) is a new candidate tumor suppressor gene. In this retrospective study, we evaluated ECRG4 protein expression in patients with nasopharyngeal carcinoma (NPC) under curative treatment and examined its association with pathological features and clinical outcomes as a possible biomarker for diagnosis and prognosis of NPC. Methods. We enrolled 122 patients with a first diagnosis between January 2001 and December 2003. Tumor tissue and control tissue from biopsies underwent immunohistochemical staining for ECRG4. ECRG4 expression was analyzed by clinicopathological variables. After Kaplan-Meier survival analysis, we used Cox proportional hazards regression to estimate the predictive effect of ECRG4 expression on overall survival. Results. ECRG4 protein level was lower in NPC than control tissue (P < 0.01). It was inversely related to node status (P < 0.001) and clinical stage (P = 0.027). ECRG4 expression was associated with overall survival, and downregulated ECRG4 expression was an independent prognostic factor of poor survival (hazard ratio = 0.677, 95 % confidence interval 0.463-0.989, P = 0.044). Conclusions. A significant NPC patients showed downregulated ECRG4 expression, which is correlated with lymph node metastasis. The marker could be an independent prognostic factor for NPC patients. The precise function of ECRG4 in the progression of NPC, especially for lymphatic metastasis, deserves further investigation, which would bring a new target for personalized therapy (AU)

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Quimioterapia metronómica para adenocarcinoma pleomorfo avanzado de nasofaringe / Metronomic chemotherapy for advanced pleomorphic adenocarcinoma of the nasopharynx

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Epstein-Barr virus-encoded small RNA 1 (EBER-1) could predict good prognosis in nasopharyngeal carcinoma

Purpose. EBER-1 (a non-coding RNA transcribed by EBV) expression was detected in most of Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma (NPC) patients. However, the relevance between EBER-1 expression and NPC clinical outcome has not been reported. This study aims to assess the possible correlations of EBER-1 expression and clinical parameters and its potential prognostic predictive ability in NPC patient’s outcomes. Methods. We examined EBER-1 mRNA expression in 301 NPC and 130 non-NPC tissues using in situ hybridization and did statistics. Results. EBER-1 expression was up-regulated in NPC tissues when compared to non-NPC tissues. A receiver operating characteristic analysis revealed that EBER-1 expression could distinguish non-cancerous patients from NPC patients (p < 0.001, sensitivity: 72.5 %, specificity: 83.5 %, AUC = 0.815). A survival analysis revealed that patients with high levels of EBER-1 expression had a significantly good prognosis (Disease-free survival: p = 0.019, overall survival: p = 0.006). Conclusion. These results indicated that EBER-1 expression is a potential prognosis factor of NPC and highly negative correlated with the progress of NPC (AU)

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Effectiveness and toxicity of helical tomotherapy for patients with locally recurrent nasopharyngeal carcinoma

Purpose. We assessed therapeutic outcomes of reirradiation with helical tomotherapy (HT) for locoregional recurrent nasopharyngeal carcinoma (LRNPC) patients. Methods and materials. Treatment outcomes were evaluated retrospectively in 17 consecutive LRNPC patients receiving HT between 2006 and 2012. Median age was 57 years and most patients (n = 13) were male. Simultaneous systemic therapy was applied in 5 patients. Initial treatment covered the gross tumor volume with a median dose of 70 Gy (60–81.6 Gy). Reirradiation was confined to the local relapse region with a median dose of 63 Gy (50–70.2 Gy), resulting in a median cumulative dose of 134 Gy (122–148.2 Gy). The median time interval between initial and subsequent treatment was 42 months (11–126). Results. The median follow-up for the entire cohort was 23 and 35 months for survivors. Three patients (18 %) developed both local and distant recurrences and only one patient (6 %) suffered from isolated local recurrence. Two-year actuarial DFS and LC rates were 74 and 82 %, respectively. Two-year OS rate was 79 %. Acute and late grade 2 toxicities were observed in 8 patients (47 %). No patient experienced late grade ≥3 toxicity. Late toxicity included fibrosis of skin, hypoacusia, dysphagia, and xerostomia. Patients with higher Karnofsky performance status scores associated with a lower risk of mortality (HR 0.85, p = 0.015). Conclusion. Reirradiation with HT in patients with LRNPC is feasible and yields encouraging results in terms of local control and overall survival with acceptable toxicity (AU)

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¿Cuál sería su diagnóstico y tratamiento? / What would your diagnosis and treatment be?

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Angiofibroma nasofaríngeo juvenil: a propósito de un caso / Juvenile nasopharyngeal angiofibroma: presentation of a case

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Impact of initial FDG PET/CT in the management plan of patients with locally advanced head and neck cancer

Objective. To determine the impact of initial FDG PET/CT staging on clinical stage and the management plan in patients with locally advanced head and neck cancer (LAHNC). Materials and methods. We retrospectively reviewed the records of 72 consecutive patients (2007–2010) staged with PET/CT and conventional CT with tumours of hypopharynx/larynx (26 patients, 36 %), oral cavity (17 patients, 24 %), oropharynx (16 patients, 22 %), nasopharynx (12 patients, 17 %), and others (2 %). The impact of PET/CT on management plans was considered high when PET/CT changed the planned treatment modality or treatment intent, and intramodality changes were considered as minor changes with low impact. Results. FDG PET/CT changed the stage in 27 patients and had high impact on the management plan in 12 % of patients (detection of distant metastases in 6 patients and stage II in 2 patients). Intramodality changes were more frequent: FDG PET/CT altered the TNM stage in 18/72 (25 %) of patients, upstaging N stage in 90 % of patients with low impact. Conclusions. Initial FDG PET/CT staging not only improves stage but also affects the management plan in LAHNC patients (AU)

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Coinfección vírica en las infecciones respiratorias infantiles / Viral Coinfection in Childhood Respiratory Tract Infections

Introducción: Las técnicas moleculares han permitido un mejor conocimiento de la etiología de las infecciones respiratorias infantiles. El objetivo del estudio fue analizar la coinfección viral y su relación con la gravedad clínica. Métodos: Se estudió a pacientes pediátricos hospitalizados con diagnóstico clínico de infección respiratoria durante el periodo comprendido entre 2009 y 2010. Se recogieron datos clínicos, epidemiológicos, duración de la hospitalización, necesidad de oxigenoterapia, coinfección bacteriana y necesidad de ventilación mecánica. Etiología estudiada con técnica PCR múltiple y microarrays de baja densidad para 19 virus. Resultados: Un total de 385 pacientes presentaron resultados positivos, 44,94% menores de 12 meses. Los virus más detectados fueron: VRS-B: 139, rhinovirus: 114, VRS-A: 111, influenza A H1N1-2009: 93 y bocavirus: 77. Se detectó coinfección en el 61,81%, un 36,36% con 2 virus, 16,10% con 3 y 9,35% con 4 o más. La coinfección fue superior en 2009 con 69,79 frente 53,88% en 2010. Rhinovirus/VRS-B en 10 ocasiones y VRS-A/VRS-B en 5 fueron las coinfecciones más detectadas. Menor hospitalización a mayor número de virus detectados (p < 0,001). Necesitaron oxigenoterapia el 26,75% (en 55,34% se aisló un virus), objetivando a mayor número de virus menor necesidad de oxígeno (p < 0,001). Precisaron ventilación mecánica 9 casos, 4 de ellos con coinfección bacteriana y 5 con coinfección vírica (p = 0,69). Conclusiones: Objetivamos una relación inversamente proporcional entre número de virus detectados en aspirado nasofaríngeo, necesidad de oxigenoterapia y días de hospitalización. Se necesitan más estudios epidemiológicos y mejoría en las técnicas de detección cuantitativa para definir el papel de las coinfecciones víricas en la enfermedad respiratoria y su correlación con la gravedad clínica

Introduction: The introduction of molecular techniques has enabled better understanding of the etiology of respiratory tract infections in children. The objective of the study was to analyze viral coinfection and its relationship to clinical severity. Methods: Hospitalized pediatric patients with a clinical diagnosis of respiratory infection were studied during the period between 2009-2010. Clinical and epidemiological data, duration of hospitalization, need for oxygen therapy, bacterial coinfection and need for mechanical ventilation were collected. Etiology was studied by multiplex PCR and low-density microarrays for 19 viruses. Results: A total of 385 patients were positive, 44.94% under 12 months. The most frequently detected viruses were RSV-B: 139, rhinovirus: 114, RSV-A: 111, influenza A H1N1-2009: 93 and bocavirus: 77. Coinfection was detected in 61.81%, 36.36% with 2 viruses, 16.10% and 9.35% with 3 to 4 or more. Coinfection was higher in 2009 with 69.79 vs. 53.88% in 2010. Rhinovirus/RSV-B on 10 times and RSV-A/RSV-B on 5 times were the most detected coinfections. Hospitalization decreased with greater number of viruses (P < 0,001). Oxygen therapy was required by 26.75% (one virus was detected in 55.34% of cases). A larger number of viruses resulted in less need for oxygen (P < 0,001). Ten cases required mechanical ventilation, 4 patients with bacterial coinfection and 5 with viral coinfection (P = 0,69). Conclusions: An inverse relationship was found between the number of viruses detected in nasopharyngeal aspirate, the need for oxygen therapy and hospitalization days. More epidemiological studies and improved quantitative detection techniques are needed to define the role of viral coinfections in respiratory disease and its correlation with the clinical severity