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Soldatova L, Campbell RG, Carrau RL, Prevedello DM, Wakely P, Otto BA, Filho LFD. Sinonasal Carcinomas with Neuroendocrine Features: Histopathological Differentiation and Treatment Outcomes. J Neurol Surg B Skull Base 2016; 77:456-465. [PMID: 27857871 PMCID: PMC5112165 DOI: 10.1055/s-0036-1582432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/26/2016] [Indexed: 10/21/2022] Open
Abstract
Objectives Sinonasal cancers with neuroendocrine features share similar clinical, radiological, and histopathological features; however, these tumors often exhibit varying degrees of aggressive behavior presenting significant treatment challenges. The objective of this study was to report our experience with these rare malignancies and to present a review of current literature. Methods Following institutional review board approval, the records of all patients with biopsy-proven sinonasal malignancies over a 5-year period were reviewed. Results The study included 14 patients with olfactory neuroblastomas (ONBs), 7 patients with sinonasal undifferentiated carcinomas (SNUC), and 2 patients with sinonasal neuroendocrine carcinomas (SNEC). Histopathologic markers aided in final diagnosis, but showed variable specificity. In patients with sufficient follow-up, the 2-year disease-free survival rate was 81% (9/11) for ONB and 75% (3/4) for SNUC. Three patients developed a regional or distant recurrence (two with ONBs and one with SNUC). Two patients, one with SNEC and one with ONB, succumbed to brain radionecrosis related to proton radiation therapy. Conclusions Overlapping clinical and histopathological features in poorly differentiated sinonasal cancers with neuroendocrine features continue to present a diagnostic challenge. Individualized assessment and treatment strategies can improve the accuracy of the initial assessment and the treatment outcomes.
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Affiliation(s)
- Liuba Soldatova
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Raewyn G. Campbell
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Ricardo L. Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Daniel M. Prevedello
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Paul Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Bradley A. Otto
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Leo F. Ditzel Filho
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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Hwang CS, Seo YW, Park SC, Chung HJ, Cho HJ, Yoon JH, Kim CH. Role of surgical treatment for esthesioneuroblastomas: 31-Year experience at a single institution. J Craniomaxillofac Surg 2016; 45:120-126. [PMID: 27840119 DOI: 10.1016/j.jcms.2016.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/31/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study aimed to re-assess the outcomes of different surgical methods for esthesioneuroblastoma (ENB) in a single institution, with emphasis on changes in surgical treatment with regard to endoscopic approaches in patients with ENB. SUBJECTS AND METHODS We retrospectively reviewed the data of 35 patients with ENB treated over the last 31 years. RESULTS The 5-year overall and disease-free survival rates were 66.8% and 50.8%, respectively. Disease-free survival in the endoscopic surgery group was significantly higher compared to that of craniofacial surgery group (P = 0.035). In the endoscopic surgery group, nine of 10 patients did not exhibit local failure or regional recurrence over a mean followup period of 64.3 months, which was longer than the mean time to recurrence (22.0 months) observed in this study. CONCLUSION Given its significant survival outcomes and high rate of local control, endoscopic surgery could be preferred as a minimally invasive treatment with potentially low morbidity and possible oncological validity for the treatment of ENB.
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Affiliation(s)
- Chi Sang Hwang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Wook Seo
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Chul Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Jin Chung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.
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Abstract
PURPOSE OF REVIEW This article provides a contemporary review of the management of esthesioneuroblastoma (ENB) within the context of recent surgical advancements, while highlighting the ongoing limitations and controversies surrounding this uncommon pathologic entity. RECENT FINDINGS Surgical management of ENB is continuously evolving with contemporary endoscopic approaches complementing or in many cases replacing open approaches. SUMMARY Complete surgical resection remains the mainstay definitive therapy for ENB. Aggressive, combined modality therapy appears to be justified in patients at greatest risk of developing recurrence based on advanced tumor stage and high pathologic grade. ENB requires prolonged surveillance following treatment given its tendency for late recurrence.
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Sabongi JG, Gonçalves MCP, Alves CDC, Alves J, Scapulatempo-Neto C, Moriguchi SM. Lutetium 177-DOTA-TATE therapy for esthesioneuroblastoma: A case report. Exp Ther Med 2016; 12:3078-3082. [PMID: 27882120 DOI: 10.3892/etm.2016.3732] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/21/2016] [Indexed: 11/06/2022] Open
Abstract
Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare malignant tumor that accounts for 3% of all tumors of the nasal cavity. The incidence of ENB is 0.4 cases per million in the general population, and the most common symptoms are nasal obstruction and epistaxis. Previous studies have indicated the presence of somatostatin receptors in this tumor type. Common treatment strategies for ENB include resection and adjuvant radiotherapy and/or chemotherapy (combined treatment); however, the rate of recurrence is high. Treatment of neuroendocrine tumors using radionuclides bound to somatostatin analogues is well established in clinical practice. However, a standard and effective therapeutic approach has not been reported for ENB. The current study described the case of a 74-year-old female with numerous recurrences of ENB following multiple treatments and without possibility of resection. The patient was treated with the radiolabeled-somatostatin analogue, 177Lutetium-DOTA-octreotate (177Lu-DOTA-TATE), which successfully controlled the disease. This suggests that 177Lu-DOTA-TATE is a potential treatment for ENB and may represent an effective alternative and novel therapeutic strategy for this disease.
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Affiliation(s)
- Juliano Guerra Sabongi
- Imaging Medical Center, Division of Nuclear Medicine, Medical Centre of Sorocaba, Sorocaba, SP 18031-480, Brazil
| | | | | | - João Alves
- Department of Nuclear Medicine, Dr Ary Pinheiro Base Hospital, Porto Velho, RO 76804-373, Brazil
| | | | - Sonia Marta Moriguchi
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, São Paulo State University, Botucatu, SP 18618-970, Brazil
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Nair R, Nayal B, Kumar V, Jaiprakash P. Esthesioneuroblastomas: Reservations and Recommendations. J Clin Diagn Res 2016; 10:PD01-4. [PMID: 27630897 DOI: 10.7860/jcdr/2016/19674.8091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/30/2016] [Indexed: 11/24/2022]
Abstract
Neuroectodermal tumour has a wide range of biological activity that ranges from an indolent course to local recurrence and rapid widespread metastasis. We describe, herewith, 2 patients with Esthesioneuroblastomas (ENB) who had varied atypical clinical presentation. The first case presented with Intracranial Pressure (ICP) headache and acute visual deterioration with radiology revealing an extra axial lesion with extension into the nasal cavity while the second case presented with nasal congestion and progressive headache of long duration. We review the unusual characteristics that may uncommonly occur in ENBs and elaborate regarding which of these must be considered when evaluating patients with this malignancy.
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Affiliation(s)
- Rajesh Nair
- Senior Registrar, Department of Neurosurgery, Kasturba Medical College , Manipal, Karnataka, India
| | - Bhavna Nayal
- Associate Professor, Department of Pathology, Kasturba Medical College , Manipal, Karnataka, India
| | - Vinod Kumar
- Associate Professor, Department of Neurosurgery, Kasturba Medical College , Manipal, Karnataka, India
| | - Padmapriya Jaiprakash
- Associate Professor, Department of Pathology, Kasturba Medical College , Manipal, Karnataka, India
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Akgul MH, Gezen F, Uzunlar AK. Esthesioneuroblastoma located in the thoracic extradural space: Case report. Int J Surg Case Rep 2016; 27:70-73. [PMID: 27552033 PMCID: PMC4995531 DOI: 10.1016/j.ijscr.2016.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/26/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022] Open
Abstract
Objective Esthesioneuroblastoma accounted for only 6% of the malignant nasal cavity neoplasms (ENB) is a rare tumor which originates from the olfactory epithelium. ENB’s are locally agresive and can metastasize by lymphatic and hematogenous routes. A patient with the mass on the nasal dorsum was reported in this article. Case history A 52–year-old-man admitted to the hospital with a 3 months history of progressive nasal obstruction, epistaxis and mass on the nasal dorsum. On rhinoscopy, a polypoid mass was seen in the both nasal cavity and intranasal biopsy with local anesthesia was performed. Histopathologic diagnosis of the tumor was Kadish stage B esthesioneuroblastoma. Tumor was excised by using bilateral endoscopic endonasal resection and lateral rhinotomy approach and paranasal radiotherapy performed postoperatively. Ten months after surgery, neck metastasis was occured and patient was underwent neck dissection. Twenteeth months after initial treatment, distant metastasis was identified on the T 10 vertebra and following the cranial and spinal radiotherapy to the neck he was free of local recurrence at follow up 13 months after surgery. Conclusion It has been known that the metastasis of the ENB to the spinal cord is an uncommon event, and it occurs often years after initial diagnosis. MRI scan is helpful for making the diagnosis, and surgery is the treatment of choice for obtaining diagnostic tissue and debulking the tumor. Radiotherapy is also a mainstay of postoperative treatment.
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Affiliation(s)
- Mehmet Hüseyin Akgul
- Kırıkkale University Medical Faculty, Department of Neurosurgery, Kirikkale, Turkey.
| | - Ferruh Gezen
- Medeniyet University Medical Faculty Department of Neurosurgery, Istanbul, Turkey.
| | - Ali Kemal Uzunlar
- Duzce University Medical Faculty, Department of Pathology, Düzce, Turkey.
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Lapierre A, Selmaji I, Samlali H, Brahmi T, Yossi S. [Esthesioneuroblastoma: A single institution's experience and general literature review]. Cancer Radiother 2016; 20:783-789. [PMID: 27449859 DOI: 10.1016/j.canrad.2016.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Olfactory neuroblastoma or esthesioneuroblastoma is a rare entity among head and neck neoplasms. In this paper, we report the experience of our institution and compare it with a comprehensive review of the literature. PATIENTS AND METHODS We retrospectively analysed clinical and treatment data of patients referred to the Lyon Sud University Hospital (France) for histologically proven olfactive esthesioneuroblastoma. RESULTS Ten patients treated between 1993 and 2015 have been analysed. Disease stage at diagnosis, according to the Kadish staging system, was C in 90% of cases. Median follow-up was 136 months. Ten-year overall survival was 90%. Five- and ten-year progression-free survival were 70% and 50%. Nine patients (90%) underwent surgical resection first. Seven of the nine patients who underwent resection (77%) received adjuvant three-dimensional (3D)-conformal radiotherapy (n=7), intensity-modulated radiotherapy (n=1), or volumetric arctherapy (n=1). The mean dose to the tumour volume was 61Gy. None of the patients received elective nodal irradiation. Two patients received concurrent chemotherapy. Five patients (50%) presented with disease recurrence, which was local (n=1), nodal (n=2) and cerebral (n=2). CONCLUSION Our results are consistent with the literature. Because of the lack of prospective study and the low number of cases in the literature, each institution's experience is of the utmost important to improve standardised management of these tumours.
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Affiliation(s)
- A Lapierre
- Département de radiothérapie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - I Selmaji
- Département de radiothérapie, centre hospitalier universitaire de Marrakech, Marrakech, Maroc
| | - H Samlali
- Département de radiothérapie, centre hospitalier universitaire de Casablanca, Casablanca, Maroc
| | - T Brahmi
- Département de radiothérapie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - S Yossi
- Département de radiothérapie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Haroon S, Tariq MU, Memon A, Fatima S, Hasan SH. Olfactory neuroblastoma: A clinicopathological experience of a rare entity from Pakistan. Pak J Med Sci 2016; 32:585-90. [PMID: 27375694 PMCID: PMC4928403 DOI: 10.12669/pjms.323.9738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives: To present the clinicopathological experience of Olfactory Neuroblastoma (ONB) with emphasis on histopathological and immunohistochemical features. Methods: A descriptive cross-sectional study was done on 36 cases of ONB, selected by non-probability purposive sampling. Theses cases of ONB were retrieved and reviewed from surgical pathology database of Aga Khan University Hospital reported between January 1993 and March 2015. Results: Tumor size and age of presentation was wide in range without any distinct bimodal distribution. Nasal cavity was most common site along with involvement of paranasal sinuses. More than 50% cases had Kadish stage A. Microscopically, most cases were Grade-1 and majority showed partial or complete lobular architecture. Neurofibrillary matrix was observed in 2/3rd of cases. Among immunohistochemical markers, Neuron Specific Enolase was most frequently expressed. Unusual positive expression of Cytokeratin AE1/AE3 and Cytokeratin CAM5.2 was also seen focally in few cases. Conclusion: The ONB has great variability of histological and clinical presentation, and immunohistochemical markers are useful to differentiate from more common small round blue cell tumours of nasal cavity.
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Affiliation(s)
- Saroona Haroon
- Dr. Saroona Haroon, MBBS, FCPS (Histopathology). Consultant and Histopathology Dept. Chair, Department of Pathology and Laboratory Medicine, Prince Faisal Cancer Centre, King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia
| | - Muhammad Usman Tariq
- Dr. Muhammad Usman Tariq, MBBS, FCPS (Histopathology). Instructor, Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Aisha Memon
- Dr. Aisha Memon, MBBS, FCPS (Histopathology). Assistant Professor and Consultant, Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Saira Fatima
- Dr. Saira Fatima, MBBS, FCPS (Histopathology). Assistant Professor and Consultant, Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Sheema Habibul Hasan
- Dr. Sheema Habibul Hasan, MBBS, FRCPath. Professor and Consultant, Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Rangel-Castilla L, Russin JJ, Spetzler RF. Surgical management of skull base tumors. Rep Pract Oncol Radiother 2016; 21:325-35. [PMID: 27330418 PMCID: PMC4899518 DOI: 10.1016/j.rpor.2014.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/21/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
Abstract
AIM To present a review of the contemporary surgical management of skull base tumors. BACKGROUND Over the last two decades, the treatment of skull base tumors has evolved from observation, to partial resection combined with other therapy modalities, to gross total resection and no adjuvant treatment with good surgical results and excellent clinical outcomes. MATERIALS AND METHODS The literature review of current surgical strategies and management of skull base tumors was performed and complemented with the experience of Barrow Neurological Institute. RESULTS Skull base tumors include meningiomas, pituitary tumors, sellar/parasellar tumors, vestibular and trigeminal schwannomas, esthesioneuroblastomas, chordomas, chondrosarcomas, and metastases. Surgical approaches include the modified orbitozygomatic, pterional, middle fossa, retrosigmoid, far lateral craniotomy, midline suboccipital craniotomy, and a combination of these approaches. The selection of an appropriate surgical approach depends on the characteristics of the patient and the tumor, as well as the experience of the neurosurgeon. CONCLUSION Modern microsurgical techniques, diagnostic imaging, intraoperative neuronavigation, and endoscopic technology have remarkably changed the concept of skull base surgery. These refinements have extended the boundaries of tumor resection with minimal morbidity.
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Affiliation(s)
| | | | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
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Abstract
Esthesioneuroblastoma is a rare malignant tumor of neuroectodermal origin. It usually presents with nonspecific symptoms, such as nasal obstruction, epistaxis, and pain, but has an aggressive course if the treatment is delayed. The authors report a case of esthesioneuroblastoma in a 47-year-old woman, treated with extensive surgical resection, radiotherapy, and chemotherapy. Despite intensive treatment, the patient developed a local recurrence with systemic metastasis and succumbed 4 months later.
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Ducic Y, Miles BA, Sabatini P. Extending the traditional resection limits of squamous cell carcinoma of the anterior skull base. Otolaryngol Head Neck Surg 2016; 137:899-905. [DOI: 10.1016/j.otohns.2007.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 08/23/2007] [Accepted: 09/06/2007] [Indexed: 11/28/2022]
Abstract
Objective Preliminary report to evaluate the efficacy of resection of squamous cell carcinomas that demonstrate intracra-nial invasion. Methods A retrospective review of all cases of extracranial squamous cell carcinomas that extend intracranially treated by a single surgeon. Results A total of 21 cases were reviewed. In 6 cases, there was noted to be overt brain invasion. Complete resection of the intracranial disease was achieved in each of the remaining 15 cases. There were no instances of CSF leak, meningitis, brain abscess, stroke, or other intracranial complication noted either acutely or secondarily. In follow-ups that ranged from 10 months (single patient died of disease at 10 months) to 6 years (average, 3.8 years), there were no instances of intracranial recurrence. There was a disease-free control rate of 67.7% at an average follow-up of 4.1 years. Conclusions Extending the resection of squamous cell carcinoma into the intracranial vault judiciously as outlined appears to be associated with acceptable outcomes in the treatment of advanced squamous cell carcinoma of the skull base.
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Affiliation(s)
- Yadranko Ducic
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, and the Division of Otolaryngology and Facial Plastic Surgery, Dallas
- John Peter Smith Hospital, Fort Worth
| | - Brett A. Miles
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, and the Division of Otolaryngology and Facial Plastic Surgery, Dallas
| | - Peter Sabatini
- Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, and the Division of Otolaryngology and Facial Plastic Surgery, Dallas
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Venkatramani R, Pan H, Furman WL, Marron JM, Haduong J, Friedrich-Medina P, Mahajan A, Bavle A, Wu H, Chintagumpala M. Multimodality Treatment of Pediatric Esthesioneuroblastoma. Pediatr Blood Cancer 2016; 63:465-70. [PMID: 26514449 PMCID: PMC5134836 DOI: 10.1002/pbc.25817] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB) is a rare cancer of the nasal cavity in children. Radical surgery followed by postoperative radiation is considered the standard of care in adults. A similar approach in children can lead to significant long-term morbidity. PROCEDURE A retrospective multi-institutional review of patients less than 21 years of age diagnosed with ENB between 1990 and 2014 was performed. Clinical features, treatment, and outcome were obtained from the medical records. RESULTS Twenty-four patients were identified with a median age of 14 years (range 0.6-20 years) at diagnosis. The majority (75%) were females. Headache was the most common presenting symptom, followed by nasal obstruction and epistaxis. Eight patients had Kadish stage B tumors and 16 had Kadish stage C tumors. Nine patients had metastatic disease. Gross total resection was achieved at diagnosis in eight patients and after neoadjuvant chemotherapy in four patients. Twenty-one patients received radiation therapy (45-68.4 Gy). Thirteen patients received neoadjuvant chemotherapy with 84% objective response rate. Seven patients experienced disease progression or relapse-five in central nervous system, one local, and one in cervical lymph node. Fifteen patients were alive at the last follow-up. The 5-year disease-free survival and overall survival were 74% and 73%, respectively. Late effects were observed in 78% of long-term survivors. Four patients developed subsequent malignant neoplasms. CONCLUSIONS Pediatric ENB is a chemosensitive disease. Preoperative chemotherapy-based multimodal approach should be used in patients with advanced stage disease. Radiation therapy is effective for local control, but lower doses should be considered in children.
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Affiliation(s)
- Rajkumar Venkatramani
- Rare Tumors Program, Texas Children’s Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Hubert Pan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Jonathan M. Marron
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | | | - Anita Mahajan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abhishek Bavle
- Rare Tumors Program, Texas Children’s Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Hao Wu
- Department of Pathology, Baylor College of Medicine, Houston, Texas
| | - Murali Chintagumpala
- Rare Tumors Program, Texas Children’s Cancer Center, Baylor College of Medicine, Houston, Texas
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Nalavenkata SB, Sacks R, Adappa ND, Palmer JN, Purkey MT, Feldman MD, Schlosser RJ, Snyderman CH, Wang EW, Woodworth BA, Smee R, Havas TE, Gallagher R, Harvey RJ. Olfactory Neuroblastoma: Fate of the Neck--A Long-term Multicenter Retrospective Study. Otolaryngol Head Neck Surg 2015; 154:383-9. [PMID: 26671900 DOI: 10.1177/0194599815620173] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 11/10/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Olfactory neuroblastoma and the management of neck disease has posed considerable challenges to the treating physician. The aims of the study were to determine the incidence and factors influencing neck disease and to identify at-risk patients with cervical node-negative disease at presentation. STUDY DESIGN Multicenter case series with retrospective chart review. SETTING AND SUBJECTS In sum, 113 patients with a histopathologic diagnosis of olfactory neuroblastoma across 6 tertiary hospitals in Australia and the United States. METHODS Treatment modalities for the primary site and neck included surgery, radiotherapy, and combined therapy. Treatment outcomes were measured in relation to date of primary treatment, and long-term follow-up was recorded. Disease-free survival was calculated as time for patients to develop delayed neck disease following primary treatment. RESULTS A total of 113 patients (46 females, 49.7 ± 13.2 years) were identified with a median follow-up of 41.5 months (interquartile range, 58.2); 7.1% of patients presented with primary neck disease, while 8.8% of patients presented with delayed neck disease. Neck disease was present in patients with Hyams grade II (22.2%), III (55.6%), and IV (22.2%) lesions (χ(2) = 5.66, P = .13). Histologic grade was higher in patients with primary neck disease (χ(2) = 16.22, P = .001). Positive surgical margins were associated with a higher risk of delayed neck disease as compared with clear surgical margin (17.9% vs 5%, P = .034). CONCLUSION Neck metastasis is an important clinical consideration for olfactory neuroblastoma at presentation and in surveillance. Primary treatment of the neck could be considered in select patients. Long-term surveillance of the neck and primary site is essential.
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Affiliation(s)
- Sunny B Nalavenkata
- Sydney Medical School, University of Sydney, Sydney, Australia Rhinology and Skull Base Research Group, Applied Medical Research Centre, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Raymond Sacks
- Sydney Medical School, University of Sydney, Sydney, Australia Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia Department of Otolaryngology, Concord General Hospital, Sydney, Australia
| | - Nithin D Adappa
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - James N Palmer
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | | | - Michael D Feldman
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Rodney J Schlosser
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Bradford A Woodworth
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, Australia
| | - Thomas E Havas
- Department of Otolaryngology, Head and Neck Surgery, Prince of Wales and Sydney Hospitals, Sydney, Australia
| | - Richard Gallagher
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, St Vincent's Hospital, University of New South Wales, Sydney, Australia Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Naples JG, Spiro J, Tessema B, Kuwada C, Kuo CL, Brown SM. Neck recurrence and mortality in esthesioneuroblastoma: Implications for management of the N0 neck. Laryngoscope 2015; 126:1373-9. [PMID: 26607219 DOI: 10.1002/lary.25803] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/11/2015] [Accepted: 10/30/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review the literature on neck recurrence in esthesioneuroblastoma. STUDY DESIGN PubMed database. METHODS A PubMed database search was performed using keywords "esthesioneuroblastoma," "olfactory neuroblastoma," and "esthesioneuroblastoma neck metastasis." Articles written in English with greater than 10 subjects that had data regarding the association of neck recurrence and mortality and/or the association of neck recurrence with Kadish stage were included for analysis. RESULTS Thirteen studies met inclusion criteria with information regarding the association of neck recurrence and mortality, and 15 studies had data associating neck recurrence and Kadish stage. The neck recurrence rate was 14.1% in studies analyzing mortality. Among those patients who developed regional metastases, mortality was 60%. Of patients without regional recurrence, the mortality rate from disease was 26% (P < 0.0001) and overall mortality was 32% (P < 0.0001). The rate of neck recurrence within each Kadish stage was 0%, 11%, 21%, and 18% for Kadish stages A, B, C, and D, respectively. The trend toward an increased incidence of neck recurrence from stage A to stage D is statistically significant, with P value 0.003. CONCLUSION The rate of neck recurrence in esthesioneuroblastoma is close to 15%. There is a strong association of recurrence with Kadish stage B and C. Mortality from disease in patients with recurrence in cervical lymph nodes is significant when compared to those who never develop neck disease. Prospective studies are needed to evaluate a potential role for elective neck dissection versus elective neck radiation for patients with esthesioneuroblastoma. LEVEL OF EVIDENCE N/A. Laryngoscope, 126:1373-1379, 2016.
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Affiliation(s)
- James G Naples
- Department of Otolaryngology, UConn Health, Farmington, Connecticut, U.S.A
| | - Jeffrey Spiro
- Department of Otolaryngology, UConn Health, Farmington, Connecticut, U.S.A
| | - Belachew Tessema
- Department of Otolaryngology, Connecticut Sinus Institute, UConn Health, Farmington, Connecticut, U.S.A
| | - Clinton Kuwada
- Department of Otolaryngology, Hartford Hospital Head and Neck Cancer Center, UConn Health, Farmington, Connecticut, U.S.A
| | - Chia-Ling Kuo
- Biostatistics Center, Community Medicine and Health Care, CT Institute for Clinical & Translational, Science, UConn Health, Farmington, Connecticut, U.S.A
| | - Seth M Brown
- Department of Otolaryngology, Connecticut Sinus Institute, UConn Health, Farmington, Connecticut, U.S.A
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Jiang W, Mohamed ASR, Fuller CD, Kim BYS, Tang C, Gunn GB, Hanna EY, Frank SJ, Su SY, Diaz E, Kupferman ME, Beadle BM, Morrison WH, Skinner H, Lai SY, El-Naggar AK, DeMonte F, Rosenthal DI, Garden AS, Phan J. The role of elective nodal irradiation for esthesioneuroblastoma patients with clinically negative neck. Pract Radiat Oncol 2015; 6:241-247. [PMID: 26979544 DOI: 10.1016/j.prro.2015.10.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/27/2015] [Accepted: 10/31/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE Although adjuvant radiation to the tumor bed has been reported to improve the clinic outcomes of esthesioneuroblastoma (ENB) patients, the role of elective neck irradiation (ENI) in clinically node-negative (N0) patients remains controversial. Here, we evaluated the effects of ENI on neck nodal relapse risk in ENB patients treated with radiation therapy as a component of multimodality treatment. METHODS AND MATERIALS Seventy-one N0 ENB patients irradiated at the University of Texas MD Anderson Cancer Center between 1970 and 2013 were identified. ENI was performed on 22 of these patients (31%). Survival analysis was performed with focus on comparative outcomes of those patients who did and did not receive ENI. RESULTS The median follow-up time for our cohort is 80.8 months (range, 6-350 months). Among N0 patients, 13 (18.3%) developed neck nodal relapses, with a median time to progression of 62.5 months. None of these 13 patients received prophylactic neck irradiation. ENI was associated with significantly improved regional nodal control at 5 years (regional control rate of 100% for ENI vs 82%, P < .001), but not overall survival or disease-free survival. Eleven patients without ENI developed isolated neck recurrences. All had further treatment for their neck disease, including neck dissection (n = 10), radiation (n = 10), or chemotherapy (n = 5). Six of these 11 patients (54.5%) demonstrated no evidence of further recurrence with a median follow-up of 55.5 months. CONCLUSION ENI significantly reduces the risk of cervical nodal recurrence in ENB patients with clinically N0 neck, but this did not translate to a survival benefit. Multimodality treatment for isolated neck recurrence provides a reasonable salvage rate. The greatest benefit for ENI appeared to be among younger patients who presented with Kadish C disease. Further studies are needed to confirm these findings.
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Affiliation(s)
- Wen Jiang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt
| | - Clifton David Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Betty Y S Kim
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - Chad Tang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shirley Y Su
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Diaz
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Michael E Kupferman
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heath Skinner
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Adel K El-Naggar
- Department of Pathology, MD Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Jack Phan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Fu TS, Monteiro E, Muhanna N, Goldstein DP, de Almeida JR. Comparison of outcomes for open versus endoscopic approaches for olfactory neuroblastoma: A systematic review and individual participant data meta-analysis. Head Neck 2015; 38 Suppl 1:E2306-16. [PMID: 26514662 DOI: 10.1002/hed.24233] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Endoscopic approaches have been adopted as an alternative to craniofacial resection in the surgical management of olfactory neuroblastoma. METHODS We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, Cochrane, and CINAHL (2000-2014) to compare outcomes for open versus endoscopic approaches. RESULTS Thirty-six studies containing 609 patients were included. Meta-analysis of (a) all patients, (b) Kadish C/D only, and (c) Hyams III/IV only, failed to show a difference in locoregional control and metastasis-free survival between approaches. However, endoscopic approaches were associated with improved overall survival (OS) for all 3 groups (p = .001, .04, and .001, respectively), and higher disease-specific survival (DSS) for all patients (p = .004) and Hyams III/IV only (p = .002). CONCLUSION The current study suggests that endoscopic approaches have comparable control rates to open approaches for olfactory neuroblastoma. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2306-E2316, 2016.
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Affiliation(s)
- Terence S Fu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nidal Muhanna
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Syndrome of inappropriate antidiuretic hormone secretion associated with olfactory neuroblastoma. J Craniofac Surg 2015; 24:2189-93. [PMID: 24220439 DOI: 10.1097/scs.0b013e3182a41c52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study reports a patient having olfactory neuroblastoma complicated by syndrome of inappropriate antidiuretic hormone secretion. Olfactory neuroblastoma is a rare tumor that begins in the olfactory membrane. Only 10 cases have been reported previously. Because of having nonspecific symptoms, most patients manifest at an advanced stage at the time of diagnosis. Olfactory neuroblastoma may show local invasion and/or distant metastasis. We demonstrated preoperatively clinical and biochemical parameters consistent with antidiuretic hormone syndrome turned to normal ranges after the treatment. Surgery, chemotherapy, and radiotherapy are the choices of treatment; among these, surgery is an indispensible treatment.
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Petruzzelli G, Howell J, Pederson A, Origitano T, Byrne R, Munoz L, Emami B, Clark J. Multidisciplinary treatment of olfactory neuroblastoma: Patterns of failure and management of recurrence. Am J Otolaryngol 2015; 36:547-53. [PMID: 25749259 DOI: 10.1016/j.amjoto.2015.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/14/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE Esthesioneuroblastoma is an uncommon malignancy of the head and neck for which there is no defined treatment protocol. The purpose of this study is to report our experience with the treatment and patterns of failure of this disease. METHODS AND MATERIALS From 1994 to 2012, 37 previously unreported patients with esthesioneuroblastoma were evaluated, and 32 eventually treated for cure at 2 academic medical centers. All patients were staged with Kadish criteria. The mean and median follow-ups were 96.1 and 76.5 months respectively (range 6-240 months). RESULTS The Kadish stage was A in 6 patients, B in 13 patients, and C in 13 patients. Four patients were initially treated with concurrent chemo-radiation therapy. Twenty-eight patients were treated with primary surgery. Two (2) underwent open medial maxillectomy and 26 underwent craniofacial resection (open - 17, endoscopic - 9). Three patients received curative surgical resection only. Seven patients failed either within the cranial axis or distantly, 6 of the 7 are dead of disease, 10-194 months following initial treatment. Six patients had isolated neck recurrences, 4/6 were salvaged with neck dissection and additional chemo-radiation and remain alive 30-194 months following initial treatment. Estimated overall survival rate at 10 years was 78% based on Kadish and T stages. CONCLUSION In this retrospective analysis of 32 patients, Kadish stage C and stage T3/T4 tumors were associated with worse outcome. Total radiation dose of 60 Gy, margin status, patient age, were not found to have significant prognostic value.
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Abstract
Sinonasal malignancies are a rare subset of malignancies of the upper aerodigestive tract which had been traditionally approached via open techniques. This article primarily addresses a paradigm shift in endoscopic endonasal oncological resection utilizing principles of tumor disassembly and negative margins. The surgical steps to these endoscopic techniques are detailed, emphasizing principles of sound oncological resection.
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Affiliation(s)
- Alexander Farag
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Marc Rosen
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA; Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA
| | - James Evans
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA; Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA 19107, USA.
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Mori T, Onimaru R, Onodera S, Tsuchiya K, Yasuda K, Hatakeyama H, Kobayashi H, Terasaka S, Homma A, Shirato H. Olfactory neuroblastoma: the long-term outcome and late toxicity of multimodal therapy including radiotherapy based on treatment planning using computed tomography. Radiat Oncol 2015; 10:88. [PMID: 25888953 PMCID: PMC4403781 DOI: 10.1186/s13014-015-0397-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background Olfactory neuroblastoma (ONB) is a rare tumor originating from olfactory epithelium. Here we retrospectively analyzed the long-term treatment outcomes and toxicity of radiotherapy for ONB patients for whom computed tomography (CT) and three-dimensional treatment planning was conducted to reappraise the role of radiotherapy in the light of recent advanced technology and chemotherapy. Methods Seventeen patients with ONB treated between July 1992 and June 2013 were included. Three patients were Kadish stage B and 14 were stage C. All patients were treated with radiotherapy with or without surgery or chemotherapy. The radiation dose was distributed from 50 Gy to 66 Gy except for one patient who received 40 Gy preoperatively. Results The median follow-up time was 95 months (range 8–173 months). The 5-year overall survival (OS) and relapse-free survival (RFS) rates were estimated at 88% and 74%, respectively. Five patients with stage C disease had recurrence with the median time to recurrence of 59 months (range 7–115 months). Late adverse events equal to or above Grade 2 in CTCAE v4.03 were observed in three patients. Conclusion Multimodal therapy including radiotherapy with precise treatment planning based on CT simulation achieved an excellent local control rate with acceptable toxicity and reasonable overall survival for patients with ONB.
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Affiliation(s)
- Takashi Mori
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan.
| | - Rikiya Onimaru
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Shunsuke Onodera
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Kazuhiko Tsuchiya
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan.
| | - Koichi Yasuda
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Hiromitsu Hatakeyama
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Hiroyuki Kobayashi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Shunsuke Terasaka
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan.
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71
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Wessell A, Singh A, Litvack Z. Preservation of olfaction after unilateral endoscopic approach for resection of esthesioneuroblastoma. J Neurol Surg Rep 2014; 75:e149-53. [PMID: 25083376 PMCID: PMC4110124 DOI: 10.1055/s-0034-1376427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022] Open
Abstract
Objectives We present a case of olfactory preservation after a unilateral transcribriform transethmoidal endoscopic resection of esthesioneuroblastoma. We also discuss the oncologic results of endoscopic and transcranial approaches and describe the potential benefits and limitations of an endoscopic approach. Setting Single academic medical center. Participant and Design The clinical course of a 28-year-old patient who underwent endoscopic en bloc resection of esthesioneuroblastoma through a unilateral transcribriform transethmoidal approach was reviewed. Results Imaging demonstrated a left-sided nasal mass with cribriform plate involvement (Kadish C). Intraoperatively, the left olfactory bulb and epithelium were sacrificed. Negative frozen sections were obtained from the right olfactory epithelium and dura surrounding the right olfactory bulb. Reconstruction was performed using a multilayered closure of fascia, rigid buttress, and nasoseptal flap. Histology was consistent with esthesioneuroblastoma. Postoperative clinical evaluation, endoscopy, and magnetic resonance imaging demonstrated no evidence of residual or recurrent tumor at 18 months. The UPSIT smell testing revealed normal olfaction preoperatively, moderate microsomia at 3 months postoperatively, and mild microsomia at 18 months postoperatively. Conclusions Endoscopic resection of esthesioneuroblastoma has demonstrated similar oncologic control while reducing postoperative morbidity and mortality over transcranial approaches. This case reveals the potential to preserve olfaction while achieving en bloc endoscopic resection of early stage esthesioneuroblastoma.
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Affiliation(s)
- Aaron Wessell
- School of Medicine, The George Washington University Medical Center, Washington, District of Columbia, United States
| | - Ameet Singh
- Department of Surgery, Division of Otolaryngology, The George Washington University Medical Center, Washington, District of Columbia, United States
| | - Zachary Litvack
- Department of Neurosurgery, The George Washington University Medical Center, Washington, District of Columbia, United States
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König MS, Osnes T, Meling TR. Treatment of esthesioneuroblastomas. Neurochirurgie 2014; 60:151-7. [PMID: 24975203 DOI: 10.1016/j.neuchi.2014.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To analyze the clinical features, treatment outcomes, pattern of failures, and course of the disease of a cohort of patients treated for esthesioneuroblastoma (ENB) with craniofacial resection (CFR) at a single institution during a 12-year period. MATERIAL AND METHODS Retrospective analysis of 11 patients with ENB treated with CFR in a tertiary care academic medical center from 1998 to 2009. RESULTS Median age at diagnosis was 51 years (range 41-67 years). The most common presenting symptom was nasal obstruction (91%). Four patients (36%) presented with Kadish stage B, six patients (55%) with Kadish stage C, and one patient (9%) with Kadish stage D. The initial treatment was craniofacial resection (CFR) alone for three patients (23%), CFR followed by postoperative radiation therapy (RT) in seven patients (64%), while one patient (9%) received both neoadjuvant and adjuvant RT in addition to surgery. The mean and median follow-up times were 66 and 58 months, respectively (range 23-158 months). Seven patients are currently alive with no evidence of disease (64%), while two patients are alive with disease (18%). Overall survival was 100% at one year postoperatively and 80% five years after the primary treatment. The progression free survival was calculated to 73% at one year and 64% at five years. CONCLUSIONS ENB is an uncommon diagnosis with an incidence of 0.037/100,000 persons/year in the catchment area of our institution. Treatment can be challenging, especially with advanced disease. CFR with RT offers good oncologic disease control with minimal morbidity.
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Affiliation(s)
- M S König
- Department of neurology, Ostfold hospital trust, 1603 Fredrikstad, Norway.
| | - T Osnes
- Department of otorhinolaryngology, Oslo university hospital, Rikshospitalet, 0027 Oslo, Norway.
| | - T R Meling
- Department of neurosurgery, Oslo university hospital, Rikshospitalet, 0027 Oslo, Norway.
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Ow TJ, Hanna EY, Roberts DB, Levine NB, El-Naggar AK, Rosenthal DI, DeMonte F, Kupferman ME. Optimization of long-term outcomes for patients with esthesioneuroblastoma. Head Neck 2014; 36:524-30. [PMID: 23780581 DOI: 10.1002/hed.23327] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Esthesioneuroblastoma is a rare cancer of the anterior cranial base that arises in the region of the olfactory rootlets. The purpose of this study was to review the long-term outcomes of patients diagnosed with esthesioneuroblastoma (ENB) treated at a single institution to determine factors associated with improved disease control and survival. METHODS A retrospective review of 70 patients with ENB treated at the University of Texas MD Anderson Cancer Center between 1992 and 2007 was undertaken. Survival and recurrence was analyzed and compared using the Kaplan-Meier method and log-rank statistics. RESULTS Seventy patients were reviewed. The majority (77%) had T3 or T4 disease at presentation, 38% identified as modified Kadish stage C or D. Ninety percent of patients received surgical resection as part of their treatment, and 66% received postoperative radiation or chemoradiation. The median follow-up was 91.4 months (7.6 years). Forty-eight percent of patients developed recurrent disease and the median time to recurrence was 6.9 years. Overall and disease-specific median survival was 10.5 and 11.6 years, respectively. Patients who were treated with surgery alone had a median disease-specific survival of 87.9 months, whereas those who were treated with surgery and postoperative radiation had a median disease-specific survival of 218.5 months (p = .047). CONCLUSION Patients with ENB can achieve favorable long-term survival, even if disease is locally advanced. Survival is improved considerably when surgical resection is followed by postoperative radiation. However, recurrence rates and mortality remain high, and therefore long-term observation in these patients is warranted.
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Affiliation(s)
- Thomas J Ow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Gallagher KK, Spector ME, Pepper JP, McKean EL, Marentette LJ, McHugh JB. Esthesioneuroblastoma: updating histologic grading as it relates to prognosis. Ann Otol Rhinol Laryngol 2014; 123:353-8. [PMID: 24668054 DOI: 10.1177/0003489414526368] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Hyams grading system has been extensively used to predict prognosis in patients with esthesioneuroblastoma (ENB). However, most studies showing prognostic correlation group grading into I/II versus III/IV, essentially comparing low versus high grade. In addition, these studies include patients with variable treatment regimens, including some that were treated with chemoradiation alone. We aimed to determine whether additional histologic variables correlate with outcome with regard to disease free and overall survival in a series of patients universally treated with anterior skull base resection and +/- adjuvant chemoradiation. STUDY DESIGN A retrospective review of 27 patients with ENB was performed. METHODS The sections of tumor from these 27 patients were studied and reviewed with attention to percentage lobularity, degree of pleomorphism, degree of neurofibrillary matrix, and degree of apoptosis. In addition, the presence or absence of rosettes, necrosis, calcification, spindle cells, gland hyperplasia, and bone invasion were noted. Finally, the number of mitoses per high power field and the nature of chromatin (fine vs coarse) were recorded. The histopathologic features of these 27 ENBs were reviewed and correlated with clinical outcome. RESULTS There were 11 patients with recurrence (40.7% recurrence). There were 5 deaths (81.5% survival). The study cohort's mean overall survival was 158 months and the mean disease-free survival was 70.6 months. In terms of overall survival, necrosis and mitosis (#/10hpf) were significant but not when multivariate analysis was performed, these were not individually significant. In terms of disease-free survival, mitosis (#/10hpf) was significant but not on multivariate analysis. Gland hyperplasia was found to be a positive prognostic variable, associated with longer overall and disease-free survival, but only in combination with no spindle features and without necrosis. CONCLUSIONS An updated histologic grading system may provide more valuable prognostic information in patients with esthesioneuroblastoma treated with a standardized treatment paradigm.
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Affiliation(s)
- Kelly K Gallagher
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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Morimoto K, Demizu Y, Hashimoto N, Mima M, Terashima K, Fujii O, Otsuki N, Murakami M, Fuwa N, Nibu KI. Particle radiotherapy using protons or carbon ions for unresectable locally advanced head and neck cancers with skull base invasion. Jpn J Clin Oncol 2014; 44:428-34. [PMID: 24620027 DOI: 10.1093/jjco/hyu010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To study the oncological outcome of the patients with unresectable locally advanced primary head and neck cancers invading the skull base, treated with particle radiotherapy. METHODS Fifty-seven patients with unresectable primary head and neck cancers invading the skull base received proton or carbon ion radiotherapy as definitive treatment at Hyogo Ion Beam Medical Center between 2003 and 2009. Forty-seven patients were treated with proton radiotherapy and 10 patients were treated with carbon ion radiotherapy. A retrospective review was performed with clinical charts and recorded imagings. RESULTS With a median follow-up of 32 months, the 3-year actual survival and local progression-free rates of all the patients were 61 and 56%, respectively. The 3-year actual survival rates of adenoid cystic carcinoma, squamous cell carcinoma, olfactory neuroblastoma, adenocarcinoma and malignant melanoma were 83, 44, 75, 0 and 38%, respectively. The 3-year actual local control rates of adenoid cystic carcinoma, squamous cell carcinoma, olfactory neuroblastoma, adenocarcinoma and malignant melanoma were 63, 31, 83, 50 and 0%, respectively. Distant metastasis was observed in 13 of 25 patients in adenoid cystic carcinoma, two of 14 patients in squamous cell carcinoma, one of six patients with olfactory neuroblastoma, two of four patients with adenocarcinoma, three of four patients with malignant melanoma and two of three patients with undifferentiated carcinoma. Mucositis and dermatitis were seen as acute toxicities. The most common late toxicity was visual disorder. Grades 2, 3 and 4 visual disorders were observed in seven, five and two patients, respectively. CONCLUSIONS Proton and carbon ion radiotherapy resulted in satisfactory local control in patients with locally advanced unresectable primary head and neck cancers invading the skull base.
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Affiliation(s)
- Koichi Morimoto
- *Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan.
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Rimmer J, Lund VJ, Beale T, Wei WI, Howard D. Olfactory neuroblastoma: a 35-year experience and suggested follow-up protocol. Laryngoscope 2014; 124:1542-9. [PMID: 24347437 DOI: 10.1002/lary.24562] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/14/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To validate a follow-up protocol based on the long-term outcomes and recurrence rates in patients who have undergone surgical treatment for olfactory neuroblastoma. METHODS A prospective review of all patients treated for olfactory neuroblastoma at our institution over a 35-year period. RESULTS Ninety-five patients were treated from 1978 to 2013, with craniofacial (65 patients) or endoscopic resection (30 patients). Duration of follow-up ranged from 1 to 309 months (mean, 88.66 months). Fifty-six patients were alive and well, and 13 were alive with recurrent disease. Twenty-one patients had died of disease, and three had died of intercurrent disease. Overall survival was 83.4% at 5 years and 76.1% at 10 years. Disease-free survival at 5 years was 80% and at 10 years was 62.8%. A Cox regression analysis showed orbital extension and intracranial involvement to be significant independent factors affecting outcome. Local and regional recurrence occurred after an average of 49 months but with a range of 3 to 233 months. CONCLUSIONS In our series, olfactory neuroblastoma most commonly recurred within the first 4 years but can recur very late, after 19.4 years in one case. There is currently no universally accepted follow-up regime, but even late recurrence is eminently treatable. We therefore propose a protocol for lifelong follow-up with both clinical examination and serial imaging, including the neck and entire intracranial compartment. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Joanne Rimmer
- Department of Otolaryngology, Royal National Throat Nose & Ear Hospital, London, United Kingdom
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77
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Kamal E, El-Fattah AMA, Emam H, Kassem M, Elashry M, Abd Elwahab AEM, Tawfik A. Esthesioneuroblastoma: Mansoura University Hospitals’ experience with multimodality therapy in 10years. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.ejenta.2012.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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78
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[Esthesioneuroblastoma]. Bull Cancer 2013; 99:1197-207. [PMID: 23022763 DOI: 10.1684/bdc.2012.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Esthesioneuroblastoma is an uncommon malignancy originating from olfactive epithelium. Men are more frequently affected than women. Nasal symptoms are the most common revealing signs. Immunohistochemistry helps diagnosis. There is no randomized trial evaluating treatment due to the low incidence of this tumor. Radiotherapy and surgery are the standard of care. Radiotherapy is benefic even in early stage disease. Chemotherapy is indicated in case of locally advanced or metastatic disease.
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79
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Abstract
Esthesioneuroblastoma is a rare malignant neoplasm in the olfactory region of the nasal cavity and anterior skull base. Diagnosis and staging require anatomic imaging and careful pathologic assessment. Standard treatment is anterior craniofacial resection with postoperative irradiation. The role for chemotherapy is not defined, but is generally for the most advanced cases and used in the neoadjuvant setting and/or postoperatively with irradiation. Prognosis is favorable; however, metastasis rates remain relatively high. Regional and distant metastasis portends a poor outcome. Intensity-modulated radiation treatment and endoscopic surgery have reduced morbidity, but outcomes with these techniques must be fully evaluated.
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Affiliation(s)
- Thomas J Ow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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80
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81
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Kaur G, Kane AJ, Sughrue ME, Madden M, Oh MC, Sun MZ, Safaee M, El-Sayed I, Aghi M, McDermott MW, Berger MS, Parsa AT. The prognostic implications of Hyam's subtype for patients with Kadish stage C esthesioneuroblastoma. J Clin Neurosci 2012; 20:281-6. [PMID: 23266076 DOI: 10.1016/j.jocn.2012.05.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/12/2012] [Indexed: 10/27/2022]
Abstract
Esthesioneuroblastoma (EN) is a rare sinonasal tumor with varied aggressiveness and potential for intracranial invasion. EN is staged anatomically with radiographic evaluation using the Kadish staging system (stages A, B, and C) and histologically by using Hyam's criteria (grades 1-4). Here we show that despite radiographic evidence of aggressive features, the prognosis of patients with Kadish stage C EN is best predicted by tumor histology using Hyam's criteria. We retrospectively analyzed patients with EN with Kadish stage C who were evaluated and treated at our institution between 1995 and 2009. Clinical information was collected using patient medical records, imaging, and review of pathological specimens. Twenty patients with Kadish stage C EN were identified with mean age of 51 years (31-70 years) with a median follow-up of 41.4 months (1.3-175 months). Upon pathological review, 44.4% of patients had low-grade (1/2) and 55.6% had high-grade (3/4) histology. About 37.5% of patients with low-grade EN had undergone gross total resection (GTR) and the remaining 62.5% had GTR and adjuvant radiation, whereas 50% of patients with high-grade ER had undergone GTR, 20% had undergone GTR and adjuvant radiation, and 30% had been treated with a subtotal resection (STR) and adjuvant radiation. The 5-year and 10-year survival in patients with low-grade EN was 86% in comparison to 56% and 28% with high-grade EN, respectively. In patients with low-grade EN, the 2-year progression free survival (PFS) was 86% and the 5-year PFS was 65% in comparison to 73% and 49% in patients with high-grade EN, respectively. The patient's tumor histology (Hyam's criteria) appeared to be the best way of predicting the prognosis and for selecting patients for adjuvant radiotherapy.
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Affiliation(s)
- Gurvinder Kaur
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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82
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Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal compared with anterior craniofacial and combined cranionasal resection of esthesioneuroblastomas. World Neurosurg 2012; 80:148-59. [PMID: 23228365 DOI: 10.1016/j.wneu.2012.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 08/19/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Esthesioneuroblastomas represent a surgical challenge because of their anatomical location, the necessity of achieving negative margins, and the often-cosmetically disfiguring transfacial approaches needed. Recently, expanded endonasal endoscopic approaches have been developed, either alone or in combination with a craniotomy. We conducted a systematic review of case series and case reports to compare outcomes between these various surgical approaches. METHODS A MEDLINE search was conducted of the modern literature (1985-2010) to identify open and endoscopic surgical series. Tumor and patient characteristics, Kadish stage, extent of resection, and progression-free and overall survival were recorded and analyzed by approach. Kaplan-Meier analysis was used to assess overall survival and progression-free survival. RESULTS Forty-seven studies comprising 453 patients were included. The endoscopic cohort had a greater proportion of Kadish Stage A tumors compared with the craniofacial group. Gross total resection was achieved in 98.1% of patients who underwent an endoscopic approach compared with 81.3% for the craniofacial and 100% for the cranionasal cohorts. Local recurrence occurred in 8.0% of patients in the endoscopic group compared with 22.1% in the craniofacial and 16.7% in the cranionasal cohorts. CONCLUSION In well-selected cases, cranionasal and endonasal approaches can be safe and effective. An ongoing evaluation of the benefits and limitations are necessary to better define the ideal patient population and patient-specific risk factors for the use of these minimal access techniques.
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Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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83
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Low-Grade Esthesioneuroblastoma Presenting as SIADH: A Review of Atypical Manifestations. Case Rep Otolaryngol 2012; 2012:582180. [PMID: 23259127 PMCID: PMC3521414 DOI: 10.1155/2012/582180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/08/2012] [Indexed: 11/24/2022] Open
Abstract
Esthesioneuroblastoma (ENB) is a neuroendocrine tumor that typically manifests as advanced stage malignancy in the superior nasal cavity. The hallmark symptoms include nasal obstruction and epistaxis, which result from local tissue invasion. Atypical clinical features can also arise and must be considered when diagnosing and treating ENB. These can include origin in an ectopic location, unusual presenting symptoms, and associated paraneoplastic syndromes. The case described here reports a nasal cavity ENB with atypical clinical features that occurred in a young female. Her tumor was low grade, appeared to arise primarily from the middle nasal cavity, and presented as syndrome of inappropriate antidiuretic hormone (SIADH). She also became pregnant shortly after diagnosis, which had implications on her surgical management. We review the atypical features that uncommonly occur with ENB and the clinical considerations that arise from these unusual characteristics.
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Kumar R, Ghoshal S, Khosla D, Bharti S, Das A, kumar N, Kapoor R, Sharma SC. Survival and failure outcomes in locally advanced esthesioneuroblastoma: a single centre experience of 15 patients. Eur Arch Otorhinolaryngol 2012. [DOI: 10.1007/s00405-012-2280-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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85
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Bak M, Wein RO. Esthesioneuroblastoma: a contemporary review of diagnosis and management. Hematol Oncol Clin North Am 2012; 26:1185-207. [PMID: 23116576 DOI: 10.1016/j.hoc.2012.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Esthesioneuroblastoma (ENB) is a rare malignancy, representing only 3% to 6% of all sinonasal malignancies. A wide array of treatment options for ENB have been described in the literature, but prospective clinical trials are absent given the tumor's rarity and natural history. Delay in diagnosis leading to an initial advanced stage of presentation is common secondary to the clinically hidden primary site at the anterior skull base. This article presents data from the current body of literature and reviews the advocated roles for surgery, radiation therapy and chemotherapy.
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Affiliation(s)
- Matthew Bak
- Eastern Virginia Medical School, Norfolk, VA 23507, USA
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86
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Chernov M, Muragaki Y, Iseki H. Letters to the editor: Esthesioneuroblastoma. J Neurosurg 2012; 117:1206-7. [PMID: 23020767 DOI: 10.3171/2010.12.jns101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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87
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Gore MR, Zanation AM. Salvage Treatment of Local Recurrence in Esthesioneuroblastoma: A Meta-analysis. Skull Base 2012; 21:1-6. [PMID: 22451793 DOI: 10.1055/s-0030-1254406] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Esthesioneuroblastoma has a local recurrence rate of ∼30%, but no standard regimen for salvage of local recurrence has been established. We report data from 678 patients from series published since 1990, with a risk reduction analysis of salvage with surgery, radiation, or combined surgery and radiation therapy. We found a 28.5% rate of local recurrence after treatment, and a 42.6% rate of successful salvage with surgery, radiation, or combined treatment. The odds ratio for successful salvage, defined as disease-free survival for at least 1 year, was not significantly different for combined surgery and radiation versus surgery alone or radiation alone or for surgery alone versus radiation alone. The salvage odds ratio for combined surgery and radiation therapy versus radiation therapy alone, 3.5, approached, but did not reach statistical significance. This study reveals a reasonable rate of successful salvage of local esthesioneuroblastoma recurrence using surgery, radiation, or combined surgery and radiation.
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Affiliation(s)
- Mitchell R Gore
- Department of Otolaryngology, Head, and Neck Surgery, University of North Carolina Hospitals, North Carolina
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88
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Kupferman ME, Demonte F, Levine N, Hanna E. Feasibility of a robotic surgical approach to reconstruct the skull base. Skull Base 2012; 21:79-82. [PMID: 22451805 DOI: 10.1055/s-0030-1261258] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The role of robotic surgery in the skull base is evolving and represents the natural progression toward maximizing surgical resections in confined spaces without compromising oncological principles. In this study, we describe the novel application of robotic surgery to the repair of dural defects in the skull base. A transmaxillary-transantral approach to the nasal cavity was performed bilaterally in a cadaveric model. Repair of the skull base defect was undertaken robotically. In this technical report, we demonstrate the feasibility of a suture-based technique for surgical reconstruction of the skull base with robotic assistance in a cadaveric model. In all cases, suture repair of dural defects was successfully performed with robotic-assisted technique. Although preliminary in nature, this study suggests that traditional suture techniques can be implemented in a confined surgical site with the use of robotic technology.
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89
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Lua BK, Lieu AS, Hwang SL, Hong SL. Recurrent pure subdural extension of esthesioneuroblastoma. FORMOSAN JOURNAL OF SURGERY 2012. [DOI: 10.1016/j.fjs.2012.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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90
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Dunbar EM, Pumphrey PK, Bidari S. Unexpectedly durable palliation of metastatic olfactory neuroblastoma using anti-angiogenic therapy with Bevacizumab. Rare Tumors 2012; 4:e33. [PMID: 22826790 PMCID: PMC3401161 DOI: 10.4081/rt.2012.e33] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 05/10/2012] [Accepted: 05/15/2012] [Indexed: 11/23/2022] Open
Abstract
Olfactory neuroblastomas (ONBs) are rare malignant tumors that arise from olfactory epithelium and typically present with symptoms attributable to locally invasive disease. Kadish radiographic staging and Hyams' histopathologic grading are prognostic. Overall survival rates, averaging 60–70% at 5 years, remain limited by high rates of delayed loco-regional and distant progression. At initial presentation, the available evidence supports the use of multimodality therapy, historically surgery and radiation, to improve disease-free and overall survival. At recurrence/progression, the available evidence supports the use of therapy to improve disease control and symptoms (palliation), but patient heterogeneity dictates individualization of modalities. Although the ideal use of chemotherapy as a modality remains undefined, the available evidence supports it use, historically platinum-based, for palliation. However, recent insights into the molecular-genetic aberrations of ONBs, coupled with the emergence chemotherapeutic agents capable of targeting such aberrations, suggest an expanded role. The authors report a case of a 60 years-old man, heavily pre-treated for metastatic ONB, presenting with profound central-nerve-system and head-and-neck symptoms. He experienced unexpectedly durable palliation with Bevacizumab anti-angiogenic therapy. Additionally, he experienced localized palliation with an Ommaya reservoir. The authors review the literature regarding historical and emerging therapies for ONB to emphasize the needs for individualization and translational-clinical studies.
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Affiliation(s)
- Erin M Dunbar
- Department of Neurosurgery, Preston A. Wells Jr., Center for Brain Tumor Therapy
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91
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Patel SG, Singh B, Stambuk HE, Carlson D, Bridger PG, Cantu G, Cheesman AD, Donald P, Fliss D, Gullane P, Kamata SE, Janecka I, Kowalski LP, Kraus DH, Levine PA, Medina LR, Pradhan S, Schramm V, Snyderman C, Wei WI, Shah JP. Craniofacial surgery for esthesioneuroblastoma: report of an international collaborative study. J Neurol Surg B Skull Base 2012; 73:208-20. [PMID: 23730550 PMCID: PMC3424016 DOI: 10.1055/s-0032-1311754] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 07/12/2011] [Indexed: 12/11/2022] Open
Abstract
Introduction Impact of treatment and prognostic indicators of outcome are relatively ill-defined in esthesioneuroblastomas (ENB) because of the rarity of these tumors. This study was undertaken to assess the impact of craniofacial resection (CFR) on outcome of ENB. Patients and Methods Data on 151 patients who underwent CFR for ENB were collected from 17 institutions that participated in an international collaborative study. Patient, tumor, treatment, and outcome data were collected by questionnaires and variables were analyzed for prognostic impact on overall, disease-specific and recurrence-free survival. The majority of tumors were staged Kadish stage C (116 or 77%). Overall, 90 patients (60%) had received treatment before CFR, radiation therapy in 51 (34%), and chemotherapy in 23 (15%). The margins of surgical resection were reported positive in 23 (15%) patients. Adjuvant postoperative radiation therapy was used in 51 (34%) and chemotherapy in 9 (6%) patients. Results Treatment-related complications were reported in 49 (32%) patients. With a median follow-up of 56 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 78, 83, and 64%, respectively. Intracranial extension of the disease and positive surgical margins were independent predictors of worse overall, disease-specific, and recurrence-free survival on multivariate analysis. Conclusion This collaborative study of patients treated at various institutions across the world demonstrates the efficacy of CFR for ENB. Intracranial extension of disease and complete surgical excision were independent prognostic predictors of outcome.
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Affiliation(s)
- Snehal G. Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York
| | - Bhuvanesh Singh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York
| | - Hilda E. Stambuk
- Department of Radiology, Memorial Sloan Kettering Cancer, New York
| | - Diane Carlson
- Laboratory Medicine/Pathology, Cleveland Clinic, Weston, Florida
| | | | | | | | | | - Dan Fliss
- Department of Otolaryngology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Patrick Gullane
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Canada
| | | | - Ivo Janecka
- Massachusetts Eye and Ear Hospital, Boston, Massachusetts
| | | | - Dennis H. Kraus
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York
| | - Paul A. Levine
- University of Virginia Health System, Charlottesville, Virginia
| | | | | | | | | | | | - Jatin P. Shah
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York
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Aggressive olfactory neuroblastoma invading the oral cavity: report of a rare case and review of the literature. J Oral Maxillofac Surg 2012; 70:e252-7. [PMID: 22374068 DOI: 10.1016/j.joms.2011.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/17/2011] [Accepted: 11/17/2011] [Indexed: 11/23/2022]
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93
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Majchrzak E, Wegner A, Golusiński W. [Diagnostic difficulties of the patient with sinonasal tract tumor; therapeutic dilemmas - a case report and up to date review]. Otolaryngol Pol 2012; 65:377-82. [PMID: 22078289 DOI: 10.1016/s0030-6657(11)70729-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 07/21/2011] [Indexed: 11/26/2022]
Abstract
Esthesioneuroblastoma (ENB) is a rare malignancy unique to the sinonasal tract. It arises from the olfactory epithelium and has a tendency to originate from one side of the nasal cavity and paranasal sinuses with frequent extension into the cranial cavity and orbit. There is a bimodal age distribution between 11 and 20 years and between 51 and 60 years. ENB accounts for approximately 2-3% of intranasal cancers. Due to the non-specific nature of the initial presentation and slow growth of the tumor, patients often have a long history before diagnosis. Physicians including pathologists are not always aware of distinctive features of ENB especially radiographic, histologic and immunohistochemical characteristics. Additional difficulty can be the fact that Esthesioneuroblastoma can histologically mimic many tumors within the sinonasal tract. We report on a 38-year-old male patient with a Kadish stage C tumor with frontal lobe invasion. The patient underwent a craniofacial resection with a combined head neck and neurosurgeon team. After the surgery postoperative radiotherapy was used. The aim of this study is to present the natural history of the malignancy, the diagnostic process, treatment and prognosis, based on the literature review.
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Affiliation(s)
- Ewa Majchrzak
- Wielkopolskie Centrum Onkologii, Oddział Chirurgii Głowy i Szyi i Onkologii Laryngologicznej.
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Nasal and paranasal esthesioneuroblastomas: clinical outcomes. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:238-43. [PMID: 22341153 DOI: 10.1016/j.anorl.2011.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 09/29/2011] [Accepted: 10/05/2011] [Indexed: 11/22/2022]
Abstract
UNLABELLED Esthesioneuroblastomas (ENB) are rare tumours derived from the olfactory epithelium. Based on their experience and a review of the literature, the authors tried to identify the epidemiological, clinical, histological and therapeutic factors that influence overall and disease-free survival in their series of ENB. METHODS This retrospective study concerned eleven patients treated in a single institution for ENB of the nasal cavity and sinuses between 1978 and 2006. The data collected were submitted to statistical analysis using R 2.0(®) software. Overall survival and disease-free survival were estimated by the Kaplan-Meier method and prognostic factors were identified by Log-Rank test. RESULTS This series comprised three women (27.2%) and eight men (72.8%) (sex ratio: 2.6). The mean age at diagnosis was 56 years (range: 37-69 years). No risk factors were identified in this cohort. The mean follow-up was 110.2 months (range: 7-348 months). This series included three T1 (27.3%), one T2 (9.1%), four T3 (36.3%) and three T4 (27.3%) tumours. The 1-year, 5-year and 10-year disease-free survival rates were 81.8%, 54.5% and 18.2%, and the corresponding overall survival rates were 100%, 90% and 60%, respectively. The main prognostic factors reported in the literature are tumour stage at diagnosis, adjuvant radiotherapy and radiation dose. CONCLUSION ENB are characterized by a high recurrence rate and recurrences can occur a very long time after the diagnosis, indicating the need for prolonged follow-up of these patients. The 5-year and 10-year overall survival rates are about 90% and 60%, respectively.
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Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic skull base surgery: a comprehensive comparison with open transcranial approaches. Br J Neurosurg 2012; 26:637-48. [PMID: 22324437 DOI: 10.3109/02688697.2012.654837] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little data exists comparing endoscopic endonasal approaches to pathology of the anterior skull base with more traditional transcranial and transsphenoidal microscopic approaches. In order to more fully characterize the role of endoscopy in the management of pathology of the anterior cranial base, we conducted a systematic review of case series and case reports documenting surgical and clinical outcomes. We found that for craniopharyngiomas, clival chordomas, esthesioneuroblastomas and giant pituitary adenomas, the endonasal endoscopic approach can result in equivalent or higher rates of gross total resection than open approaches. For meningiomas, however, open transcranial approaches are still able to achieve higher rates of total resection. CSF leak rates are higher for patients undergoing endoscopic surgery for meningiomas and craniopharyngiomas, but not for chordomas, esthesioneuroblastomas or giant pituitary adenomas. In certain patients, the endonasal endoscopic approach may be a safe and effective alternative for the treatment of a wide variety of skull base pathology, particularly those with small midline tumours.
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Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
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Abstract
PURPOSE Because of paucity of data available regarding the utility of PET/CT in the diagnosis and staging of patients with olfactory neuroblastoma (ONB), we retrospectively analyzed the efficacy of PET/CT in 9 patients with ONB. MATERIALS AND METHODS Whole-body F-18 FDG PET/CT was performed in 7 patients with newly diagnosed ONB, as well as in 1 patient with recurrence and in 1 patient with remnant tumor. Regional C-11 choline (C-11 CHO) PET/CT was performed in 2 patients with negative F-18 FDG scans. The lesion with intense radiotracer uptake was suggested as positive for tumor and the results of PET/CT were compared with conventional staging examinations. RESULTS F-18 FDG PET/CT was positive in 7/9 (77.7%) patients with ONB. In 2 patients with negative F-18 FDG, the lesions were C-11CHO avid. Both the primary tumors and its invasions were clearly delineated by F-18 FDG or C-11 CHO PET/CT. SUVmax of F-18 FDG in the primary tumor was 6.37 ± 4.22 and did not correlate with lesion size (F-18 FDG/size: r = 0.097, P = 0.820). Whole-body F-18 FDG PET/CT detected parapharyngeal and cervical lymph node metastases in 2 patients, lung metastases in 1 patient, liver metastases in 1 patients, and bone metastases in 2 patients. PET/CT altered the stages of 3 of 9 patients with upstaging in 2 patients and downstaging in 1 patient. CONCLUSIONS PET/CT may be useful for the diagnosis and staging of ONB.
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Metastatic esthesioneuroblastoma secreting adrenocorticotropic hormone in pediatric patients. J Craniofac Surg 2011; 22:1924-9. [PMID: 21959469 DOI: 10.1097/scs.0b013e318210bce4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this article was to report a pediatric case of secondary cervical esthesioneuroblastoma involving the parapharyngeal lymph nodes. A 3-year-old boy came to our clinical observation because of a right lymphonodal mass evidenced by nuclear magnetic resonance and a diagnosis of Cushing syndrome associated with ectopic adrenocorticotropic hormone secretion, moon face, central obesity, asthenia, and hirsutism. At the age of 10 months, the patient underwent endoscopic surgery for asportation of the World Health Organization stage IV esthesioneuroblastoma. At 38 months of age, the patient underwent right parapharyngeal lymphadenectomy with surgical access by a double mandibulectomy. After surgery, serum ACTH, cortisolemia, and urinary excretion of cortisol were within the reference range. Blood pressure was recorded at 110/70 mm Hg. Moon face disappeared, as well as central obesity and hirsutism. Clinical report is presented together with brief review of literature.
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Trecarichi EM, Galli J, Tamburrini E, de Donati KG, Scoppettuolo G, Colosimo C, Pierconti F, Paludetti G, Tumbarello M. Esthesioneuroblastoma in an HIV-1 Infected Patient: Case Report. SKULL BASE REPORTS 2011; 1:129-32. [PMID: 23984215 PMCID: PMC3743599 DOI: 10.1055/s-0031-1284208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 04/26/2011] [Indexed: 11/18/2022]
Abstract
Esthesioneuroblastoma (ENB) is an uncommon malignant tumor derived from the specialized neuroepithelium of the upper nasal cavity. The largest case series and meta-analyses suggest the combination of surgery and radiotherapy as the gold standard treatment for ENB. However, an increasing number of case series have reported excellent survival and few complications with minimally invasive endoscopic resection (MIER) in conjunction with radiotherapy of EBN in early stages of the disease. In this case report, the authors describe the first case of ENB in a young adult man who was human immunodeficiency virus (HIV)-1 and Hepatitis C virus (HCV) coinfected. The authors discuss all the aspects of this rare disease, focusing on treatment options and prognosis.
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Ward PD, Heth JA, Thompson BG, Marentette LJ. Esthesioneuroblastoma: Results and Outcomes of a Single Institution's Experience. Skull Base 2011; 19:133-40. [PMID: 19721769 DOI: 10.1055/s-0028-1096195] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Analysis of outcomes of a cohort of patients with esthesioneuroblastoma. DESIGN Retrospective cohort analysis. SETTING PATIENTS presenting with esthesioneuroblastoma from 1994 to 2006 in a tertiary care academic medical center. PATIENTS Fifteen consecutive patients diagnosed as having esthesioneuroblastoma were treated during this time period using a subcranial resection. The mean follow-up is 75 months (range, 2 to 240 mos). RESULTS The overall survival was 100% and the overall disease-free survival was 49% and 24% at 5 and 15 years, respectively. PATIENTS treated with radiation therapy following surgical resection had a 5- and 15-year disease-free survival of 83.3% compared with a 5- and 15-year disease-free survival of 26.7% and 0%, respectively, for patients whose initial treatment was surgery alone. The mean time to recurrence was 82.1 months. None of the patients had a decrease in Karnofsky Performance Score following subcranial resection. CONCLUSIONS PATIENTS with esthesioneuroblastoma whose initial treatment consists of surgical resection followed by radiation therapy have a longer disease-free survival than patients treated with surgery alone. However, initial treatment modality did not have an effect on survival. Long-term, close follow-up is necessary to identify recurrences, which can be treated with a high degree of success.
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Affiliation(s)
- P Daniel Ward
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan
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Nabili V, Kelly DF, Fatemi N, St John M, Calcaterra TC, Abemayor E. Transnasal, transfacial, anterior skull base resection of olfactory neuroblastoma. Am J Otolaryngol 2011; 32:279-85. [PMID: 20728963 DOI: 10.1016/j.amjoto.2010.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 05/17/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE Using a transnasal, transfacial, anterior skull base approach, we have removed olfactory neuroblastomas (OFN) obviating the need for a frontal craniotomy. The objectives were to present our surgical approach in achieving clear margins, to assess patient survival, and to recommend eligibility criteria. MATERIALS AND METHODS A retrospective chart review was done to identify patients diagnosed with OFN who underwent this surgical approach. Thirteen patients were identified who underwent our pictorially described approach. Postoperative assessment of pathologic margins, patient survival, and limitations of surgical approach was determined. RESULTS Of the 13 patients, 12 (92%) had clear postsurgical margins. One patient had residual intracranial disease due to coagulopathy preventing further resection. Twelve patients remain alive with 10 patients remaining disease-free (follow-up ranging from 11 to 64 months). Three patients presented with recurrent disease initially, with 2 having had subsequent repeat local and regional recurrences, respectively; one of whom died recently of the re-recurrent disease. One patient had a postoperative cerebrospinal fluid leak repaired via the original surgical approach. CONCLUSIONS Although craniofacial resection remains an accepted approach for surgical treatment of OFN, we have adopted a transnasal, transfacial approach eliminating the need for a frontal craniotomy. This approach allows for adequate exposure of the cribriform plate, dura, and anterior skull base. Our technique minimizes dural defects and prevents many craniotomy-associated complications, including frontal lobe retraction. Long-term follow-up is needed to compare survival using this approach; however, our results to date are quite promising.
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Affiliation(s)
- Vishad Nabili
- Divisions of Head and Neck Surgery, David Geffen School of Medicine at UCLA, University of California-Los Angeles, 10833 LeConte Avenue, Los Angeles, CA 90095, USA.
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