Radiotherapy for esthesioneuroblastoma: is elective nodal irradiation warranted in the multimodality treatment approach?

Abstract

PURPOSE:

The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) has not been clearly defined. We analyzed treatment outcomes of patients with ENB and the frequency of cervical nodal failure in the absence of ENI.

METHODS AND MATERIALS:

Between August 1996 and December 2007, we consulted with 19 patients with ENB regarding radiotherapy. Initial treatment consisted of surgery alone in 2 patients; surgery and postoperative radiotherapy in 4; surgery and adjuvant chemotherapy in 1; surgery, postoperative radiotherapy, and chemotherapy in 3; and chemotherapy followed by radiotherapy or concurrent chemoradiotherapy in 5. Five patients did not receive planned radiotherapy because of disease progression. Including 2 patients who received salvage radiotherapy, 14 patients were treated with radiotherapy. Elective nodal irradiation was performed in 4 patients with high-risk factors, including 3 with cervical lymph node metastasis at presentation.

RESULTS:

Fourteen patients were analyzable, with a median follow-up of 27 months (range, 7-64 months). The overall 3-year survival rate was 73.4%. Local failure occurred in 3 patients (21.4%), regional cervical failure in 3 (21.4%), and distant failure in 2 (14.3%). No cervical nodal failure occurred in patients treated with combined systemic chemotherapy regardless of ENI. Three cervical failures occurred in the 4 patients treated with ENI or neck dissection (75%), none of whom received systemic chemotherapy.

CONCLUSIONS:

ENI during radiotherapy for ENB seems to play a limited role in preventing cervical nodal failure. Omitting ENI may be an option if patients are treated with a combination of radiotherapy and chemotherapy.

• Authors: O Kyu Noh, Sang-wook Lee, Sang Min Yoon, Sung Bae Kim, Sang Yoon Kim, Chang Jin Kim, Kyung Ja Jo, Eun Kyung Choi, Si Yeol Song, Jong Hoon Kim, Seung Do Ahn
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 79 Issue 2 Pg. 443-9 (Feb 01 2011) ISSN: 1879-355X [Electronic] United States
• PMID: 20421144 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Child
• Combined Modality Therapy (methods)
• Esthesioneuroblastoma, Olfactory (drug therapy, pathology, radiotherapy, surgery)
• Female
• Follow-Up Studies
• Humans
• Lymphatic Irradiation (methods)
• Lymphatic Metastasis (radiotherapy)
• Male
• Middle Aged
• Nasal Cavity
• Nose Neoplasms (drug therapy, pathology, radiotherapy, surgery)
• Survival Rate
• Treatment Outcome
• Young Adult