ENB is a rare malignancy, with optimal management remaining uncertain. Our experience suggests that aggressive management seems successful in providing sustained LRC with acceptable long-term toxicity. The role of elective nodal irradiation to the upper neck remains unclear.
David Zaenger, MD, Bryan M. Rabatic, PhD, MD, Joseph M. Kaminski, MD, Waleed F. Mourad, MD, PhD; Georgia Regents University
PURPOSE: We report our multimodality functional and oncologic outcomes in the management of esthesioneuroblastoma (ENB).
MATERIALS: This is a single-institution retrospective study of 22 patients treated between 1998 and 2014 for ENB. The median age was 47 years (range: 29–68 yr); 13 patients (59%) were male. The percentages of patients in Kadish stages A, B, and C were 45%, 32%, and 23%, respectively. Two patients (9%) received definitive induction chemotherapy, followed by chemoradiation therapy (CRT) (70 Gy), and 20 patients (91%) received postoperative RT (PORT) to a median dose of 59.4 Gy (range: 54–63 Gy). Intensity-modulated radiation therapy (IMRT) was utilized in 64% of the whole cohort. PORT fields included the preoperative tumor bed and elective bilateral upper neck lymph node (LN) levels IB and II.
RESULTS: The median follow-up for the whole cohort was 40 months (range: 12–150 mo). The actuarial 4-year disease-free survival (DFS) was 68%. The 4-year actuarial overall survival (OS) was 86%. The 4-year actuarial locoregional control (LRC) was 68%, and distant control (DC) was 95%. Of the seven failures, two developed infield local failure and underwent successful salvage surgery and SRS boost, three patients failed locoregionally (primary site and neck), one failed regionally (neck alone), and one developed simultaneous local and distant failure. Recurrences manifested as late as 112 months. No adverse events related to vision were reported. A total of 10% developed short-term grade 3 dysphagia, without long-term percutaneous endoscopic gastrostomy (PEG) tube dependency.
CONCLUSIONS: ENB is a rare malignancy, with optimal management remaining uncertain. Our experience suggests that aggressive management seems successful in providing sustained LRC with acceptable long-term toxicity. The role of elective nodal irradiation to the upper neck remains unclear.
Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org