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Ariizumi Y, Asakage T. Development of an evaluation and treatment strategy for olfactory neuroblastoma: a review of evidence from large-scale studies, including population-based and multicenter studies, and meta-analyses. Jpn J Clin Oncol 2024; 54:847-862. [PMID: 38762332 DOI: 10.1093/jjco/hyae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024] Open
Abstract
Olfactory neuroblastoma is a rare sinonasal malignancy arising from the olfactory epithelium that is characterized by skull base involvement and a modest natural history. Because of its rarity and long course, identification of independent prognostic factors is dependent on multivariate analysis of large, long-term data. In this review, we outline evidence for the evaluation and treatment of olfactory neuroblastoma obtained from recent large-scale population-based studies, meta-analyses and multicenter studies. Hyams grade is currently the only pathological grade system for olfactory neuroblastoma. The modified Kadish staging and Dulguerov classification are available for clinical staging. The results of large-scale studies have confirmed Hyams, the modified Kadish and Dulguerov as independent prognostic factors. Surgery followed by radiotherapy provides the best overall survival and recurrence-free survival for resectable disease. The question of whether postoperative radiotherapy should be administered for all cases or only for those at risk of recurrence remains unanswered. Exclusively endoscopic resection is indicated for modified Kadish A/B cases without any increase in the risk of death or recurrence, and is also indicated for modified Kadish C cases if a negative surgical margin is ensured. For more advanced cases, such as those with extensive brain infiltration, the open approach is indicated. Elective nodal irradiation prevents late nodal recurrence of N0 patients. Chemotherapy has failed to show a benefit in survival or disease control. Current needs for olfactory neuroblastoma include the development and validation of refined staging systems suitable for current practice; expansion of indications for endoscopic surgery; less invasive surgery; definitive radiotherapy and novel systemic therapy.
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Affiliation(s)
- Yosuke Ariizumi
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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2
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Li Y, Zhao X, Tao Y. Endoscopy-assisted medial canthus incision for olfactory neuroblastoma: a case report. World J Surg Oncol 2024; 22:163. [PMID: 38909260 PMCID: PMC11193278 DOI: 10.1186/s12957-024-03448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/16/2024] [Indexed: 06/24/2024] Open
Abstract
Sinonasal malignant tumors are a group of uncommon malignancies that account for less than 1% of all tumors. These tumors often involve the maxillary sinus and nasal cavity, with less cumulative incidence in the ethmoidal sinus, sphenoidal sinus, and frontal sinus. The lack of consensus on the management of sinonasal malignancies is due to their rarity, diagnostic challenges, and the heterogeneity of treatments. In this paper, we present a case of endoscopic-assisted medial canthus incision combined with radiotherapy in the treatment of sinonasal malignant tumors, with the aim of providing valuable insights to clinicians on the management of these tumors.
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Affiliation(s)
- Yanwen Li
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Xin Zhao
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Yanli Tao
- Weifang People's Hospital, No. 151 Guangwen Street, Kuiwen District, Wei- fang, 261041, Shandong, China.
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MIZUMOTO MARIE, FURUKAWA TATSUYA, YUI MITSUKO, IRITANI KEISUKE, TATEHARA SHUN, INOKUCHI GO, TESHIMA MASANORI, SHINOMIYA HIROTAKA, KIMURA HIDEHITO, KIYOTA NAOMI, SASAKI RYOHEI, NIBU KENICHI. A Case of Olfactory Neuroblastoma Developing Bilateral Retropharyngeal Lymph Node Metastasis 14-years After Skull Base Surgery. THE KOBE JOURNAL OF MEDICAL SCIENCES 2024; 70:E56-E60. [PMID: 38936878 PMCID: PMC11216656 DOI: 10.24546/0100489917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/13/2024] [Indexed: 06/29/2024]
Abstract
Olfactory neuroblastoma (ONB) is an uncommon malignant tumor and is usually treated by a multidisciplinary approach includes surgery, radiotherapy, and chemotherapy. A 62 years-old male had a tumor in the nasal cavity and diagnosed as ONB with Kadish A stage. Anterior skull base surgery was performed as radical treatment. Since the surgical margin was negative, no postoperative radiotherapy was administered. 14 years after the surgery, bilateral otitis media with effusion (OME) was occurred, we found the recurrence tumor at bilateral retropharyngeal lymph node (RPLN) which surrounded the internal carotid arteries. Since these were unresectable, we planned chemoradiotherapy which was 70Gy of intensity modulated radiotherapy combined with two courses of carboplatin and etoposide. The tumor volume was reduced and bilateral OME were improved. He has been alive for 3 years after salvage treatment. Although ONB has a relatively good prognosis, it is known to often cause cervical lymph node metastasis. Grades III and IV of Hyams classification are considered high risk. This case, initial tumor was limited in the nasal cavity and its clinical classification was early stage, but Hyams classification was grade III. In reference to this case, considering that RPLN metastasis are difficult to radically resect at the salvage surgery, including this area in postoperative radiotherapy was considered an option.
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Affiliation(s)
- MARIE MIZUMOTO
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - TATSUYA FURUKAWA
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - MITSUKO YUI
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - KEISUKE IRITANI
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - SHUN TATEHARA
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - GO INOKUCHI
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - MASANORI TESHIMA
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - HIROTAKA SHINOMIYA
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - HIDEHITO KIMURA
- Department of Neurosurgery, Kobe University Hospital, Kobe, Japan
| | - NAOMI KIYOTA
- Cancer Center, Kobe University Hospital, Kobe, Japan
| | - RYOHEI SASAKI
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | - KEN-ICHI NIBU
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
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Lopez F, Agaimy A, Franchi A, Suárez C, Vander Poorten V, Mäkitie AA, Homma A, Eisbruch A, Olsen KD, Saba NF, Nuyts S, Snyderman C, Beitler JJ, Corry J, Hanna E, Hellquist H, Rinaldo A, Ferlito A. Update on olfactory neuroblastoma. Virchows Arch 2024; 484:567-585. [PMID: 38386106 DOI: 10.1007/s00428-024-03758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
Olfactory neuroblastomas are uncommon malignancies that arise from olfactory receptor cells located high in the nasal cavity. Accurate diagnosis plays a crucial role in determining clinical results and guiding treatment decisions. Diagnosis can be a major challenge for pathologists, especially when dealing with tumours with poor differentiation. The discovery of several molecular and immunohistochemical markers would help to overcome classification difficulties. Due to the paucity of large-scale studies, standardisation of diagnosis, treatment and prediction of outcome remains a challenge. Surgical resection by endoscopic techniques with the addition of postoperative irradiation is the treatment of choice. In addition, it is advisable to consider elective neck irradiation to minimise the risk of nodal recurrence. Molecular characterisation will help not only to make more accurate diagnoses but also to identify specific molecular targets that can be used to develop personalised treatment options tailored to each patient. The present review aims to summarise the current state of knowledge on histopathological diagnosis, the molecular biology and management of this disease.
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Affiliation(s)
- Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Avenida de Roma, S/N, 33011, Oviedo, Asturias, Spain.
| | - Abbas Agaimy
- Institut Für Pathologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alessandro Franchi
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, 56126, Pisa, Italy
| | | | - Vincent Vander Poorten
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Oncology, Section of Head and Neck Oncology, KU Leuven, and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Research Program in Systems Oncology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Akihiro Homma
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sandra Nuyts
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven-University of Leuven, 3000, Leuven, Belgium
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - June Corry
- Division of Radiation Oncology, GenesisCare Radiation Oncology, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Ehab Hanna
- Department of Head & Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Henrik Hellquist
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Algarve Biomedical Center Research Institute (ABC-RI), 8005-139, Faro, Portugal
- Department of Cellular Pathology, Northern Lincolnshire and Goole NHS Foundation Trust, Lincoln, LN2 5QY, UK
| | | | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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Lui CG, Badash I, Tang L, Mark ME, Batra PS, Wrobel BB. Ectopic Olfactory Neuroblastoma: Systematic Review of a Rare Clinical Entity among Sinonasal Tumors. J Neurol Surg B Skull Base 2024; 85:109-118. [PMID: 38463937 PMCID: PMC10923629 DOI: 10.1055/a-1993-7790] [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: 07/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Ectopic olfactory neuroblastoma is an uncommon manifestation of an already rare neoplasm. We aimed to systematically review the literature for cases of ectopic olfactory neuroblastoma to better characterize this rare disease entity and to present two new case reports. Methods A search of the PubMed and Embase databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify English-language articles reporting cases of ectopic olfactory neuroblastoma, published from 1955 through November 2021. Results Sixty-six cases of ectopic olfactory neuroblastoma were identified in 62 articles including the current review. Ectopic olfactory neuroblastoma arose in a wide age range (2-89 years) without significant sex predilection. It occurred most commonly in the ethmoid (25%), maxillary (25%), and sphenoid (16%) sinuses. Seventy-three percent of cases presented with low Hyams grade (I and II). The most common symptoms were nasal obstruction (32%) and epistaxis (32%). Paraneoplastic syndromes were observed in 27% of patients. The most common treatment was surgical resection followed by adjuvant radiotherapy. Overall, 76% of all patients were disease-free at the time of last follow-up. Locoregional recurrences and distant metastases were found in 19 and 5% of cases, respectively. Conclusion This systematic review describes previously reported cases of ectopic olfactory neuroblastoma, a disease entity with poorly understood characteristics. Physicians should consider olfactory neuroblastoma in the differential diagnosis for sinonasal masses, as their ectopic presentation may present considerable diagnostic and therapeutic difficulties. Patients with olfactory neuroblastoma may benefit from long-term follow-up and routine endoscopic examinations for surveillance of ectopic recurrences.
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Affiliation(s)
- Christopher G. Lui
- Department of Otolaryngology - Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Ido Badash
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Liyang Tang
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Michelle E. Mark
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Pete S. Batra
- Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Bozena B. Wrobel
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Nair LM, Mathew JM, Rafi M, Thommachan KC, KM JK, Varghese BT, Ravikumar R. Treatment outcomes and prognostic factors of esthesioneuroblastoma-a retrospective study from South India. Ecancermedicalscience 2023; 17:1584. [PMID: 37533955 PMCID: PMC10393312 DOI: 10.3332/ecancer.2023.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Indexed: 08/04/2023] Open
Abstract
Esthesioneuroblastoma (ENB) or olfactory neuroblastoma is a rare malignant neoplasm arising from the neural crest cells of the olfactory epithelium. The optimum treatment for this rare disease is still unclear. Most of the available literature on this rare head and neck tumour is limited to small retrospective series and single institutional reports. We conducted a retrospective study to investigate the clinical profile, treatment outcomes and prognostic factors of patients with ENB treated at a tertiary cancer centre in south India. Patients with a histopathological diagnosis of ENB treated from 2000 to 2019 were included. Patient demographics, tumour characteristics, stage, treatment details and outcome data were identified from medical records. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method and the log-rank test was used for comparison. The prognostic factors were identified using Cox regression analysis. Forty-two patients underwent treatment for ENB from 2000 to 2019. Twenty-six patients underwent surgery. Twelve patients received radical radiotherapy (RT) while 24 patients underwent adjuvant radiation. After a median follow-up of 71 months, the estimated OS and DFS at 4 years were 64.4% and 54%, respectively. The estimated 4-year OS for modified Kadish A, B, C and D stages was 75.0%, 90.9%, 56.4% and 0%, respectively. Modified Kadish stage, nodal involvement, orbital invasion, intracranial extension, surgery, RT treatment and use of chemotherapy were significant predictors of OS and DFS in univariate Cox regression analysis. Orbital invasion and RT treatment were significant predictors of DFS in the multivariate analysis as well. However, only RT treatment came out to be a significant predictor for OS in multivariate Cox regression analysis. Surgery is the mainstay of treatment. Adjuvant RT may improve local control and survival in advanced cases. Advanced modified Kadish stage, lymph node involvement and orbital invasion are associated with poor outcomes.
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Affiliation(s)
- Lekha Madhavan Nair
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - John Mohan Mathew
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - Malu Rafi
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | | | - Jagathnath Krishna KM
- Department of Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - Bipin T Varghese
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - Rejnish Ravikumar
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
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7
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Finlay JB, Abi Hachem R, Jang DW, Osazuwa-Peters N, Goldstein BJ. Deconstructing Olfactory Epithelium Developmental Pathways in Olfactory Neuroblastoma. CANCER RESEARCH COMMUNICATIONS 2023; 3:980-990. [PMID: 37377616 PMCID: PMC10243222 DOI: 10.1158/2767-9764.crc-23-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/13/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023]
Abstract
Olfactory neuroblastoma is a rare tumor arising from the olfactory cleft region of the nasal cavity. Because of the low incidence of this tumor, as well as an absence of established cell lines and murine models, understanding the mechanisms driving olfactory neuroblastoma pathobiology has been challenging. Here, we sought to apply advances from research on the human olfactory epithelial neurogenic niche, along with new biocomputational approaches, to better understand the cellular and molecular factors in low- and high-grade olfactory neuroblastoma and how specific transcriptomic markers may predict prognosis. We analyzed a total of 19 olfactory neuroblastoma samples with available bulk RNA-sequencing and survival data, along with 10 samples from normal olfactory epithelium. A bulk RNA-sequencing deconvolution model identified a significant increase in globose basal cell (GBC) and CD8 T-cell identities in high-grade tumors (GBC from ∼0% to 8%, CD8 T cell from 0.7% to 2.2%), and significant decreases in mature neuronal, Bowman's gland, and olfactory ensheathing programs, in high-grade tumors (mature neuronal from 3.7% to ∼0%, Bowman's gland from 18.6% to 10.5%, olfactory ensheathing from 3.4% to 1.1%). Trajectory analysis identified potential regulatory pathways in proliferative olfactory neuroblastoma cells, including PRC2, which was validated by immunofluorescence staining. Survival analysis guided by gene expression in bulk RNA-sequencing data identified favorable prognostic markers such as SOX9, S100B, and PLP1 expression. Significance Our analyses provide a basis for additional research on olfactory neuroblastoma management, as well as identification of potential new prognostic markers.
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Affiliation(s)
- John B. Finlay
- Medical Scientist Training Program, Duke University School of Medicine, Durham, North Carolina
- Department of Head and Neck Surgery & Communication Sciences, Duke University, School of Medicine, Durham, North Carolina
- Department of Cell and Molecular Biology, Duke University School of Medicine, Durham, North Carolina
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery & Communication Sciences, Duke University, School of Medicine, Durham, North Carolina
| | - David W. Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, School of Medicine, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University, School of Medicine, Durham, North Carolina
| | - Bradley J. Goldstein
- Department of Head and Neck Surgery & Communication Sciences, Duke University, School of Medicine, Durham, North Carolina
- Department of Cell and Molecular Biology, Duke University School of Medicine, Durham, North Carolina
- Department of Neurobiology, Duke University School of Medicine, Durham, North Carolina
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8
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Rooper LM. Proceedings of the 2023 North American Society of Head and Neck Pathology Companion Meeting, New Orleans, LA, March 12, 2023: Navigating New Developments in High Grade Sinonasal Neuroendocrine and Neuroectodermal Neoplasms. Head Neck Pathol 2023; 17:299-312. [PMID: 37184733 PMCID: PMC10293143 DOI: 10.1007/s12105-023-01548-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/18/2023] [Indexed: 05/16/2023]
Abstract
Although the definitions of sinonasal neuroendocrine and neuroectodermal neoplasms did not change substantially in the 5th edition WHO Classification of Head and Neck Tumours, the diagnosis of olfactory neuroblastoma (ONB), small cell neuroendocrine carcinoma, and large cell neuroendocrine carcinoma remains quite challenging in practice. Ambiguities surrounding the amount of keratin expression allowable in ONB and the amount of neuroendocrine differentiation seen in sinonasal undifferentiated carcinoma (SNUC) lead to significant diagnostic discrepancies at the high grade end of this tumor spectrum. Furthermore, a group of problematic neuroepithelial tumors that show overlapping features of ONB and neuroendocrine carcinoma have never been recognized in formal classification schemes. Since publication of the 5th edition WHO, two new tumor entities have been proposed that help resolve these problems. Olfactory carcinoma is defined by high grade keratin-positive neuroectodermal cells with frequent intermixed glands and shows recurrent Wnt pathway, ARID1A, and RUNX1 alterations. IDH2-mutant sinonasal carcinoma is a molecularly-defined category that encompasses tumors with undifferentiated (SNUC), large cell neuroendocrine, and neuroepithelial phenotypes. This review will provide a practical overview of these emerging entities and their application to diagnostic challenges in the post-WHO sinonasal neuroendocrine and neuroectodermal tumor classification.
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Affiliation(s)
- Lisa M Rooper
- Department of Pathology, The Johns Hopkins University School of Medicine, 401 N. Broadway, Weinberg 2242, Baltimore, MD, 21231, USA.
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Zunitch MJ, Fisch AS, Lin B, Barrios-Camacho CM, Faquin WC, Tachie-Baffour Y, Louie JD, Jang W, Curry WT, Gray ST, Lin DT, Schwob JE, Holbrook EH. Molecular Evidence for Olfactory Neuroblastoma as a Tumor of Malignant Globose Basal Cells. Mod Pathol 2023; 36:100122. [PMID: 36841178 PMCID: PMC10198888 DOI: 10.1016/j.modpat.2023.100122] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
Olfactory neuroblastoma (ONB, esthesioneuroblastoma) is a sinonasal cancer with an underdeveloped diagnostic toolkit, and is the subject of many incidents of tumor misclassification throughout the literature. Despite its name, connections between the cancer and normal cells of the olfactory epithelium have not been systematically explored and markers of olfactory epithelial cell types are not deployed in clinical practice. Here, we utilize an integrated human-mouse single-cell atlas of the nasal mucosa, including the olfactory epithelium, to identify transcriptomic programs that link ONB to a specific population of stem/progenitor cells known as olfactory epithelial globose basal cells (GBCs). Expression of a GBC transcription factor NEUROD1 distinguishes both low- and high-grade ONB from sinonasal undifferentiated carcinoma, a potential histologic mimic with a distinctly unfavorable prognosis. Furthermore, we identify a reproducible subpopulation of highly proliferative ONB cells expressing the GBC stemness marker EZH2, suggesting that EZH2 inhibition may play a role in the targeted treatment of ONB. Finally, we study the cellular states comprising ONB parenchyma using single-cell transcriptomics and identify evidence of a conserved GBC transcriptional regulatory circuit that governs divergent neuronal-versus-sustentacular differentiation. These results link ONB to a specific cell type for the first time and identify conserved developmental pathways within ONB that inform diagnostic, prognostic, and mechanistic investigation.
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Affiliation(s)
- Matthew J Zunitch
- Medical Scientist Training Program, Tufts University School of Medicine, Boston, Massachusetts; Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, Massachusetts
| | - Adam S Fisch
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Lin
- Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yaw Tachie-Baffour
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, Massachusetts
| | - Jonathan D Louie
- Medical Scientist Training Program, Tufts University School of Medicine, Boston, Massachusetts; Department of Neuroscience, Tufts University School of Medicine, Boston, Massachusetts
| | - Woochan Jang
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, Massachusetts
| | - William T Curry
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - James E Schwob
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, Massachusetts; Department of Neuroscience, Tufts University School of Medicine, Boston, Massachusetts.
| | - Eric H Holbrook
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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10
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Recurrent Esthesioneuroblastoma: Long-Term Outcomes of Salvage Therapy. Cancers (Basel) 2023; 15:cancers15051506. [PMID: 36900297 PMCID: PMC10000736 DOI: 10.3390/cancers15051506] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Esthesioneuroblastoma (ENB) is a rare malignant neoplasm arising from the olfactory epithelium of the cribriform plate. Although survival is excellent with a reported 5-year overall survival (OS) of 82%, recurrence is frequent and occurs in 40-50% of cases. This study investigates the characteristics of ENB recurrence and the subsequent prognosis of patients with recurrence. METHODS The clinical records of all patients diagnosed as having ENB with subsequent recurrence at a tertiary hospital from 1 January 1960 to 1 January 2020 were retrospectively reviewed. Overall survival (OS) and progression-free survival (PFS) were reported. RESULTS A total of 64 out of 143 ENB patients had recurrences. In total, 45 out of 64 recurrences met the inclusion criteria and were included in this study. From these, 10 (22%) had a sinonasal recurrence, 14 (31%) had an intracranial recurrence, 15 (33%) had a regional recurrence, and 6 (13%) had a distal recurrence. The average interval from initial treatment to recurrence was 4.74 years. There were no differences in rates of recurrence with respect to age, sex, or types of surgery (endoscopic, transcranial, lateral rhinotomy, and combined). The time to recurrence was shorter for Hyams grades 3 and 4 compared to Hyams grades 1 and 2 (3.75 years vs. 5.70 years, p < 0.05). Patients with recurrence limited to the sinonasal region had a lower overall primary Kadish stage compared to recurrences beyond the sinonasal region (2.60 vs. 3.03, p < 0.05). A total of 9 (20%) out of 45 patients developed secondary recurrence. Following recurrence, the subsequent 5-year OS and PFS were 63 and 56%, respectively. The mean time to secondary recurrence after treatment of the primary recurrence was 32 months, which was significantly shorter than the time to primary recurrence (32 months vs. 57 months, p = 0.048). The mean age of the secondary recurrence group is significantly older than the primary recurrence group (59.78 years vs. 50.31 years, p = 0.02). No statistically significant differences were observed between the secondary recurrence group and the recurrence group in terms of their overall Kadish stages or Hyams grades. CONCLUSIONS Following an ENB recurrence, salvage therapy appears to be an effective therapeutic option with a subsequent 5-year OS of 63%. However, subsequent recurrences are not infrequent and may require additional therapy.
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Henson JC, Cutler CC, Cole KL, Lucke-Wold B, Khan M, Alt JA, Karsy M. Immunohistochemical Profiling and Staging in Esthesioneuroblastoma: A Single-Center Cohort Study and Systematic Review. World Neurosurg 2023; 170:e652-e665. [PMID: 36435382 DOI: 10.1016/j.wneu.2022.11.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Esthesioneuroblastoma (ENB) is a rare sinonasal malignant neoplasm with 40% 5-year survival. Because of the rarity of the tumor, the optimal treatment and subsequent prediction of prognosis are unclear. We studied a modern series of patients with ENB to evaluate the association of immunohistochemical (IHC) markers and clinical stages/grades with outcomes. METHODS A single-center retrospective review of patients with ENB treated during a 25-year period was performed. A systematic literature review evaluating the prognostic benefits of current staging systems in evaluating survival outcomes in ENB was undertaken. RESULTS Among 29 included patients, 25 (85%) were treated surgically at our institution, with 76% of those endoscopically resected; 7 (24.1%) received chemotherapy, and 18 (62.1%) received radiation therapy. The 5-year overall survival (OS) was 91.3%, and 10-year OS was 78.3%. Progression-free survival at 5 and 10 years was 85.6% and 68.2%, respectively. A total of 36 distinct IHC markers were used to diagnose ENB but were inconsistent in predicting survival. A systematic literature review revealed predictive accuracy for OS using the Kadish, TNM, and Hyams staging/grading systems was 68%, 42%, and 50%, respectively. CONCLUSIONS This study reports the 5- and 10-year OS and progression-free survival in a modern series of patients with ENB. No traditional IHC marker consistently predicted outcome. Some novel reviewed markers show promise but have yet to enter clinical mainstream use. Our systematic review of accepted staging/grading systems also demonstrated a need for further investigation due to limited prognostic accuracy.
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Affiliation(s)
- J Curran Henson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Chris C Cutler
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, College of Medicine, North Chicago, Illinois, USA
| | - Kyril L Cole
- College of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Majid Khan
- School of Medicine, University of Nevada Reno, Reno, Nevada, USA
| | - Jeremiah A Alt
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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12
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Olfactory Neuroblastoma: Morphological Reappraisal and Molecular Insights with Quantum Leap in Clinical Perspectives. Curr Oncol Rep 2023; 25:11-18. [PMID: 36449116 DOI: 10.1007/s11912-022-01348-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE OF REVIEW The purpose of review is to provide a comprehensive review of the literature focusing on the recent advances in the diagnosis, molecular underpinning, and targeted therapy of olfactory neuroblastoma (ONB). RECENT FINDINGS Studies focused on the molecular fingerprinting of ONB are critical to engage new promising treatment strategies. Molecular-based subtype classifications have been proposed (basal-like ONB and neural-like ONB) but are not widely used. The rationale for implementation of DNA methylation analysis and IDH2 sequencing in routine work-up for ONB is gaining recognition. Expression of somatostatin receptors (SSTR) in ONB open new avenues for both, diagnostic (especially metastatic disease) and new treatment protocols with somatostatin analogs. Olfactory carcinoma is proposed as a unifying diagnostic terminology pertinent to epithelial divergent differentiation in olfactory neuroblastoma. Molecular (genetic and epigenetic) efforts on olfactory neuroblastoma are promising; however further refinement is needed for employment of these biomarkers as clinical standard of care. Ongoing and future multi-institutional collaborative studies will contribute to further understanding of ONB biology and aid the development of targeted treatments for this disease.
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13
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Arosio AD, Bernasconi DP, Valsecchi MG, Pacifico C, Battaglia P, Bignami M, Ferrari M, Mattavelli D, Rampinelli V, Tomasoni M, Schreiber A, Gualtieri T, Piazza C, Magrini SM, Tartaro T, Molteni M, Lambertoni A, Sileo G, Bossi P, Orlandi E, Bertazzoni G, Fiaux-Camous D, Jourdaine C, Verillaud B, Herman P, Nicolai P, Castelnuovo P, Turri-Zanoni M. Patterns of recurrences in sinonasal cancers undergoing an endoscopic surgery-based treatment: Results of the MUSES* on 940 patients: *MUlti-institutional collaborative Study on Endoscopically treated Sinonasal cancers. Oral Oncol 2022; 134:106123. [PMID: 36174456 DOI: 10.1016/j.oraloncology.2022.106123] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/18/2022] [Accepted: 09/04/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The improvements in survival with expansion of the survivors' population, along with evolution of endoscopically-based treatment modalities, have contributed to emphasize the clinical relevance of recurrences in sinonasal cancers. However, at present, literature is scant regarding the pattern of recurrences and the therapeutic strategies available to manage long survivors who experienced single or multiple failures. The aim of the present study was to analyze sinonasal cancers recurrences to provide data regarding rates and patterns of relapse, predictors of failure and prognostic impact of the recurrence. MATERIALS AND METHODS All patients receiving multimodal treatments including endoscopic surgery between 1995 and 2021 in three European referral centers were included. Statistical analysis of survival was performed through univariable, multivariable and unidirectional multistate models. Survival after recurrence analysis was implemented for patients experiencing at least one recurrence. RESULTS The 5- and 10-year recurrence free survival rates were 34.1% and 38.4% for the whole population. With a mean follow-up time of 60 months, a global recurrence rate of 32.9% was observed. The 5- and 10-year survival after recurrence rates were 27.2% and 21.7%, respectively. Incidence and rates of recurrences were significantly associated with histology subtypes. CONCLUSION This study provides valuable oncologic outcomes regarding a large homogenous cohort of patients affected by sinonasal malignances treated within a multimodal framework, emphasizing the strong correlation of histologic type with prognosis, as well as with pattern of recurrences.
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Affiliation(s)
- Alberto Daniele Arosio
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy.
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Claudia Pacifico
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Otorhinolaryngology, "ASST Lariana", University of Insubria, Como, Italy
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Tommaso Gualtieri
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Stefano Maria Magrini
- Unit of Radiation Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Tiziana Tartaro
- Department of Medical Oncology, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Marinella Molteni
- Department of Radiotherapy, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Alessia Lambertoni
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Giorgio Sileo
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy
| | - Paolo Bossi
- Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | | | - Clement Jourdaine
- Department of Otorhinolaryngology, Lariboisière University Hospital, Paris, France
| | - Benjamin Verillaud
- Department of Otorhinolaryngology, Lariboisière University Hospital, Paris, France
| | - Philippe Herman
- Department of Otorhinolaryngology, Lariboisière University Hospital, Paris, France
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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14
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Furukawa T, Tatehara S, Teshima M, Shinomiya H, Inokuchi G, Komatsu M, Hara S, Zen Y, Nibu KI. Expressions of NeuroD and GAP43 as diagnostic markers for olfactory neuroblastoma. Auris Nasus Larynx 2022; 50:358-364. [PMID: 35999123 DOI: 10.1016/j.anl.2022.08.004] [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: 01/28/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Olfactory neuroblastoma (ONB) is often difficult to pathologically distinguish from other small round cell tumors (SRCTs) arising in the nasal cavities. Although there are several diagnostic markers used for differential diagnosis of ONB, these molecules are also expressed in various neuronal derived tumors. Here, we examined the expression of NeuroD, GAP43, and olfactory marker protein (OMP) in ONB and non-ONB SRCT to determine their utility in the differential diagnosis of ONB. METHODS Twenty-six patients diagnosed with and treated for ONB at Kobe University Hospital between 1997 and 2017 with formalin-fixed, paraffin-embedded biopsy or surgical resection specimens were included. The expressions of NeuroD, GAP43, and OMP were immunohistochemically examined in these 26 ONB specimens and specimens from 13 SRCTs arising in the nasal cavities for reference. RESULTS Among the 26 ONB samples, focal, patchy, and marked staining for NeuroD was observed in 4, 3, and 9 samples, respectively. Focal, patchy, and marked GAP43 staining was observed in 5, 3, and 11 samples, respectively. Consequently, marked positive staining for either NeuroD or GAP43 was observed in 54% (14/26) of ONBs. Among the 13 SRCTs, marked staining for NeuroD was observed in two small cell carcinomas, one undifferentiated carcinoma, and one neuroendocrine carcinoma, whereas marked positive staining for GAP43 was observed only in one undifferentiated carcinoma. No specimen in this study exhibited OMP staining. CONCLUSIONS Our results suggest possible roles of GAP43 immunostaining in the differential diagnosis of ONB.
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Affiliation(s)
- Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Shun Tatehara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Go Inokuchi
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Komatsu
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shigeo Hara
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan; Kobe City Medical Center General Hospital, Department of Pathology, Kobe, Japan
| | - Yoh Zen
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan; Institute of Liver Studies, King's College Hospital & King's College London, London, UK
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Gupta S, Bi WL, Annino DJ, Dunn IF. Dramatic response to targeted therapy in an aggressive olfactory neuroblastoma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21663. [PMID: 35733633 PMCID: PMC9204913 DOI: 10.3171/case21663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Olfactory neuroblastomas are rare sinonasal tumors that arise from the olfactory epithelium. The authors presented a case of an olfactory neuroblastoma with extensive cranial invasion that demonstrated dramatic response to sorafenib, a tyrosine kinase inhibitor. OBSERVATIONS A 54-year-old man with history of prostate cancer and melanoma presented with left-sided proptosis and was found to have a 6.5-cm Kadish stage D olfactory neuroblastoma with cranial invasion that was refractory to chemotherapy and everolimus. However, it demonstrated dramatic response to sorafenib, causing extensive skull base defects that prompted operative repair. Genomic analysis of the tumor revealed mutations in TSC1 and SUFU. The patient developed disease progression with liver metastases 35 months after starting sorafenib, prompting a change to lenvatinib. He experienced progression of his olfactory neuroblastoma 10 months following this change and died in hospice 1 month later. LESSONS The authors reviewed the clinical presentation and management of a large olfactory neuroblastoma with dramatic response to sorafenib. They highlighted prior uses of targeted therapy in the management of refractory olfactory neuroblastoma within the context of current standard treatment regimens. Targeted therapies may play a vital role in the management of refractory olfactory neuroblastoma.
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Affiliation(s)
- Saksham Gupta
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, and
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, and
| | - Donald J. Annino
- Department of Otolaryngology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Ian F. Dunn
- Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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16
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Uccella S, Facco C, Chiaravalli AM, Pettenon F, La Rosa S, Turri-Zanoni M, Castelnuovo P, Cerati M, Sessa F. Transcription Factor Expression in Sinonasal Neuroendocrine Neoplasms and Olfactory Neuroblastoma (ONB): Hyams' Grades 1-3 ONBs Expand the Spectrum of SATB2 and GATA3-Positive Neoplasms. Endocr Pathol 2022; 33:264-273. [PMID: 35522392 PMCID: PMC9135868 DOI: 10.1007/s12022-022-09715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
Sinonasal neuroendocrine neoplasms (SN-NENs) are rare and mostly include neuroendocrine carcinoma (NEC), whereas neuroendocrine tumor (NET) is exceptional in this site. Olfactory neuroblastoma (ONB) is a malignant neuroectodermal neoplasm arising in the nasal cavity. Albeit crucial for correct patients' management, the distinction of high grade ONB from NEC is challenging and requires additional diagnostic markers. The transcription factor SATB2 has been recently introduced in routine diagnostics as an immunohistochemical marker of distal intestine differentiation. No specific data are available about SATB2 and GATA3 expression in SN-NENs. GATA3, SATB2, and, for comparison, CDX2 expression were investigated in a series of epithelial and non-epithelial SN-NENs. We collected 26 cases of ONB and 7 cases of epithelial SN-NENs diagnosed and treated in our Institution. ONBs were graded according to Hyams' system and epithelial NENs were reclassified into 5 NECs, 1 MiNEN, and 1 amphicrine carcinoma. Immunohistochemistry was performed using standard automated protocols. Hyams' grades 1-3 ONBs stained diffusely and intensely for SATB2, whereas grade 4 ONBs and NECs were globally negative. The non-neuroendocrine component of MiNEN and the amphicrine carcinoma were strongly positive. GATA3 was heterogeneously and unpredictably expressed in Hyams' grades 1-3 ONBs, whereas grade 4 ONBs and NECs were completely negative. CDX2 was negative in all cases. Our study identifies, for the first time, SATB2 and GATA3 expression as features of Hyams' grades 1-3 ONBs, expands the spectrum of SATB2 and GATA3-positive neoplasms, and suggests that Hyams' grade 4 ONBs are not only clinically but also biologically different from low graded ONBs.
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Affiliation(s)
- Silvia Uccella
- Unit of Pathology, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy.
| | - Carla Facco
- Dept. of Pathology, ASST Dei Sette Laghi, Varese, Italy
| | | | - Fabiana Pettenon
- Unit of Pathology, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
| | - Stefano La Rosa
- Unit of Pathology, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
| | - Mario Turri-Zanoni
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | | | - Fausto Sessa
- Unit of Pathology, Dept. of Medicine and Surgery, University of Insubria, via O. Rossi 9, 21100, Varese, Italy
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17
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McMillan RA, Van Gompel JJ, Link MJ, Moore EJ, Price DL, Stokken JL, Van Abel KM, O'Byrne J, Giannini C, Chintakuntlawar A, Pinheiro Neto CD, Peris Celda M, Foote R, Choby G. Long-term oncologic outcomes in esthesioneuroblastoma: An institutional experience of 143 patients. Int Forum Allergy Rhinol 2022; 12:1457-1467. [PMID: 35385606 DOI: 10.1002/alr.23007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Esthesioneuroblastoma (ENB) is a rare malignant neoplasm arising from the olfactory epithelium of the cribriform plate. The goal of this study was to update our oncologic outcomes for this disease and explore prognostic factors associated with survival. MATERIALS AND METHODS We performed a retrospective analysis of patients with ENB treated at a single tertiary care institution from January 1, 1960, to January 1, 2020. Univariate and multivariate analysis was performed. Overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival (DMFS) were reported. RESULTS Among 143 included patients, the 5-year OS was 82.3% and the 5-year PFS was 51.6%; 5-year OS and PFS have improved in the modern era (2005-present). Delayed regional nodal metastasis was the most common site of recurrence in 22% of patients (median, 57 months). On univariate analysis, modified Kadish staging (mKadish) had a negative effect on OS, PFS, and DMFS (p < 0.05). Higher Hyams grade had a negative effect on PFS and DMFS (p < 0.05). Positive margin status had a negative effect on PFS (p < 0.05). Orbital invasion demonstrated worsening OS (hazard ratio, 3.1; p < 0.05). On multivariable analysis, high Hyams grade (3 or 4), high mKadish stage (C+D), and increasing age were independent negative prognostic factors for OS (p < 0.05). High Hyams grade (3+4), high mKadish stage (C+D), age, and positive margin status were independent negative prognostic factors for PFS (p < 0.05). High Hyams grade (3+4) was an independent negative prognostic factor for DMFS (p < 0.05). CONCLUSIONS Patients with low Hyams grade and mKadish stage have favorable 5-year OS, PFS, and DMFS.
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Affiliation(s)
- Ryan A McMillan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Janalee L Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Jamie O'Byrne
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Carlos D Pinheiro Neto
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Maria Peris Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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18
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Lechner M, Takahashi Y, Turri-Zanoni M, Liu J, Counsell N, Hermsen M, Kaur RP, Zhao T, Ramanathan M, Schartinger VH, Emanuel O, Helman S, Varghese J, Dudas J, Riechelmann H, Sprung S, Haybaeck J, Howard D, Engel NW, Stewart S, Brooks L, Pickles JC, Jacques TS, Fenton TR, Williams L, Vaz FM, O'Flynn P, Stimpson P, Wang S, Hannan SA, Unadkat S, Hughes J, Dwivedi R, Forde CT, Randhawa P, Gane S, Joseph J, Andrews PJ, Royle G, Franchi A, Maragliano R, Battocchio S, Bewicke-Copley H, Pipinikas C, Webster A, Thirlwell C, Ho D, Teschendorff A, Zhu T, Steele CD, Pillay N, Vanhaesebroeck B, Mohyeldin A, Fernandez-Miranda J, Park KW, Le QT, West RB, Saade R, Manes RP, Omay SB, Vining EM, Judson BL, Yarbrough WG, Sansovini M, Silvia N, Grassi I, Bongiovanni A, Capper D, Schüller U, Thavaraj S, Sandison A, Surda P, Hopkins C, Ferrari M, Mattavelli D, Rampinelli V, Facchetti F, Nicolai P, Bossi P, Henriquez OA, Magliocca K, Solares CA, Wise SK, Llorente JL, Patel ZM, Nayak JV, Hwang PH, Lacy PD, Woods R, O'Neill JP, Jay A, Carnell D, Forster MD, Ishii M, London NR, Bell DM, Gallia GL, Castelnuovo P, Severi S, Lund VJ, Hanna EY. Clinical outcomes, Kadish-INSICA staging and therapeutic targeting of somatostatin receptor 2 in olfactory neuroblastoma. Eur J Cancer 2022; 162:221-236. [PMID: 34980502 PMCID: PMC9554673 DOI: 10.1016/j.ejca.2021.09.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Olfactory neuroblastoma (ONB) is a rare cancer of the sinonasal region. We provide a comprehensive analysis of this malignancy with molecular and clinical trial data on a subset of our cohort to report on the potential efficacy of somatostatin receptor 2 (SSTR2)-targeting imaging and therapy. METHODS We conducted a retrospective analysis of 404 primary, locally recurrent, and metastatic olfactory neuroblastoma (ONB) patients from 12 institutions in the United States of America, United Kingdom and Europe. Clinicopathological characteristics and treatment approach were evaluated. SSTR2 expression, SSTR2-targeted imaging and the efficacy of peptide receptor radionuclide therapy [PRRT](177Lu-DOTATATE) were reported in a subset of our cohort (LUTHREE trial; NCT03454763). RESULTS Dural infiltration at presentation was a significant predictor of overall survival (OS) and disease-free survival (DFS) in primary cases (n = 278). Kadish-Morita staging and Dulguerov T-stage both had limitations regarding their prognostic value. Multivariable survival analysis demonstrated improved outcomes with lower stage and receipt of adjuvant radiotherapy. Prophylactic neck irradiation significantly reduces the rate of nodal recurrence. 82.4% of the cohort were positive for SSTR2; treatment of three metastatic cases with SSTR2-targeted peptide-radionuclide receptor therapy (PRRT) in the LUTHREE trial was well-tolerated and resulted in stable disease (SD). CONCLUSIONS This study presents pertinent clinical data from the largest dataset, to date, on ONB. We identify key prognostic markers and integrate these into an updated staging system, highlight the importance of adjuvant radiotherapy across all disease stages, the utility of prophylactic neck irradiation and the potential efficacy of targeting SSTR2 to manage disease.
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, London, UK; Academic Head and Neck Centre, UCL Division of Surgery and Interventional Science, University College London, London, UK; ENT Department, Barts Health NHS Trust, London, United Kingdom; Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA.
| | - Yoko Takahashi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mario Turri-Zanoni
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, London, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Mario Hermsen
- Department of Head and Neck Oncology, Instituto de Investigacio´n Sanitaria Del Principado de Asturias (ISPA), Instituto Universitario de Oncologı´a Del Principado de Asturias (IUOPA), Centro de Investigacio´n Biome´dica en Red (CIBER-ONC), Oviedo, Spain
| | - Raman Preet Kaur
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA
| | - Tianna Zhao
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA
| | - Volker H Schartinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Oscar Emanuel
- UCL Cancer Institute, University College London, London, UK
| | - Sam Helman
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Jordan Varghese
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Jozsef Dudas
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Susanne Sprung
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Haybaeck
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria; Diagnostic & Research Center for Molecular BioMedicine, Institute of Pathology, Medical University Graz, Graz, Austria
| | - David Howard
- Head and Neck Cancer Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Nils Wolfgang Engel
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Stewart
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Laura Brooks
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Jessica C Pickles
- Department of Developmental Biology and Cancer & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas S Jacques
- Department of Developmental Biology and Cancer & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tim R Fenton
- School of Biosciences, University of Kent, Canterbury, UK; School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Luke Williams
- UCL Division of Surgery and Interventional Science, University College London, London, UK
| | - Francis M Vaz
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Paul O'Flynn
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Paul Stimpson
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Simon Wang
- Institute of Nuclear Medicine, University College London, London, UK
| | - S Alam Hannan
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Samit Unadkat
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Jonathan Hughes
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Raghav Dwivedi
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Cillian T Forde
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Premjit Randhawa
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Simon Gane
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Jonathan Joseph
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Peter J Andrews
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Gary Royle
- UCL Cancer Institute, University College London, London, UK
| | | | - Roberta Maragliano
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Simonetta Battocchio
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | | | | | - Amy Webster
- UCL Cancer Institute, University College London, London, UK
| | - Chrissie Thirlwell
- UCL Cancer Institute, University College London, London, UK; College of Medicine and Health and Institute of Biomedical and Clinical Science, University of Exeter, Exeter, UK
| | - Debbie Ho
- Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Andrew Teschendorff
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Shanghai, China
| | - Tianyu Zhu
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Shanghai, China
| | - Christopher D Steele
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | | | - Ahmed Mohyeldin
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, USA
| | | | - Ki Wan Park
- Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, USA
| | - Robert B West
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, USA
| | - Rami Saade
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Peter Manes
- Department of Neurosurgery, Yale School of Medicine, New Haven, USA
| | | | - Eugenia M Vining
- Department of Neurosurgery, Yale School of Medicine, New Haven, USA
| | | | - Wendell G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine, Chapel Hill, NC, USA
| | - Maddalena Sansovini
- Therapeutic Nuclear Medicine, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Nicolini Silvia
- Therapeutic Nuclear Medicine, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Ilaria Grassi
- Therapeutic Nuclear Medicine, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center (CDO-TR), IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - David Capper
- Department of Neuropathology, Charite - Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin, Germany; German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, Institute of Neuropathology, And Research Institute Children's Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Selvam Thavaraj
- Centre for Clinical, Oral & Translational Science, King's College London, Department of Head and Neck Pathology, Guy's Hospital, London, UK
| | - Ann Sandison
- Department of Head and Neck Pathology, Guy's Hospital, London, UK
| | | | | | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Oswaldo A Henriquez
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Kelly Magliocca
- Department of Pathology, Emory University School of Medicine, Atlanta, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, USA
| | - Jose L Llorente
- Dept Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Zara M Patel
- Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Jayakar V Nayak
- Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Peter H Hwang
- Rhinology & Endoscopic Skull Base Surgery, Department of Otolaryngology-H&N Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Peter D Lacy
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Robbie Woods
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - James P O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland; The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Amrita Jay
- Department of Histopathology, University College London Hospitals NHS Trust, London, UK
| | - Dawn Carnell
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Martin D Forster
- UCL Cancer Institute, University College London, London, UK; Academic Head and Neck Centre, UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Oncology, Haematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Masaru Ishii
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA
| | - Nyall R London
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA; Sinonasal and Skull Base Tumor Program, Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - Diana M Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center Houston, USA; Division of Anatomic Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Gary L Gallia
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Paolo Castelnuovo
- Unit of Otorhinolaryngology and Head & Neck Surgery, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Stefano Severi
- Therapeutic Nuclear Medicine, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Valerie J Lund
- Royal National Ear, Nose and Throat Hospital and Head and Neck Centre, University College London Hospitals NHS Trust, London, UK.
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
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19
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Ziai H, Yu E, Weinreb I, Perez-Ordonez B, Yao CMKL, Xu W, Yang D, Witterick IJ, Monteiro E, Gilbert RW, Irish JC, Gullane PJ, Goldstein DP, Ringash J, Bayley A, de Almeida JR. Regional Recurrences and Hyams Grade in Esthesioneuroblastoma. J Neurol Surg B Skull Base 2021; 82:608-614. [PMID: 34745827 DOI: 10.1055/s-0040-1715809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/02/2020] [Indexed: 10/23/2022] Open
Abstract
Objective The aim of this study is to determine if Hyams grade may help predict which patients with esthesioneuroblastoma (ENB) tumors are likely to develop regional recurrences, and to determine the impact of tumor extent on regional failure in ENB patients without evidence of nodal disease at presentation. Design The study was designed as a retrospective review for ENB patients. Settings The study was prepared at tertiary care academic center for ENB patients. Participants Patients with ENB were included in the study. Main Outcome Measures Oncologic outcomes (5-year regional and locoregional control (LRC) and overall survival) in patients with Hyams low grade versus high grade. Oncologic outcomes based on radiographic disease extent. Results A total of 43 patients were included. Total 25 patients (58%) had Hyams low-grade tumor, and 18 (42%) had high-grade tumor. Of the 34 patients without regional disease at presentation, 8 (24%) were treated with elective nodal radiation. There were no statistically significant differences in 5-year regional control in the Hyams low-grade versus high-grade groups (78 vs. 89%; p = 0.4). The 5-year LRC rates in patients with low grade versus high grade were 73 versus 89% ( p = 0.6). The 5-year overall survival rates in patients with low-grade versus high-grade tumors were 86 versus 63% ( p = 0.1). Radiographic extension of disease into the olfactory groove, olfactory nerve, dura, and periorbita were statistically associated with decreased 5-year overall survival (5-year OS 49 vs. 91% [ p = 0.04], 49 vs. 91% [ p = 0.04], 44 vs. 92% [ p = 0.02], and 44 vs. 80% [ p = 0.04], respectively). Conclusion ENBs are associated with a risk of regional failure. The current analysis suggests that Hyams low-grade and high-grade malignancies have comparable rates of early and delayed regional recurrences, although small sample size may limit our conclusions.
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Affiliation(s)
- Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yu
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ilan Weinreb
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Bayardo Perez-Ordonez
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, the Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Dongyang Yang
- Department of Biostatistics, the Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- 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
| | - Jolie Ringash
- Department of Radiation Oncology, the Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, the Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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20
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Surgical Management of Sinonasal Cancers: A Comprehensive Review. Cancers (Basel) 2021; 13:cancers13163995. [PMID: 34439150 PMCID: PMC8393312 DOI: 10.3390/cancers13163995] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/21/2022] Open
Abstract
Surgery plays an important role in the treatment of sinonasal cancer. Many surgical approaches have been described, including open, endoscopic, or combined approaches. The choice is based on several criteria: general criteria related to the oncological results and morbidity of each technique, specific criteria related to the tumor (tumor extensions, tumor pathology), the patient, or the surgeon himself. The aims of this review are (i) to provide a complete overview of the surgical techniques available for the management of sinonasal malignant tumors, with a special focus on recent developments in the field of transnasal endoscopic surgery; (ii) to summarize the criteria that lead to the choice of one technique over another. In particular, the oncological outcomes, the morbidity of the different techniques, and the specificities of each histologic subtype will be discussed based on a comprehensive literature review.
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21
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Consolidating the Hyams grading system in esthesioneuroblastoma - an individual participant data meta-analysis. J Neurooncol 2021; 153:15-22. [PMID: 33770323 DOI: 10.1007/s11060-021-03746-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Esthesioneuroblastoma (ENB) is an uncommon primary sinonasal tumor which can extend intracranially. Exactly how to classify them pathologically still remains discrepant; the Hyams grading system, for example, has not been universally adopted. This individual patient data (IPD) meta-analysis aimed to investigate the prognostic implication of each Hyams grade on patient outcomes. METHODS We accessed two electronic databases including PubMed and Web of Science. Raw patient data from potential articles were extracted. To examine the associations of various clinicopathological factors with the Hyams grades, we utilized Chi-square, t-test, and Mann-Whitney, as appropriate. Log-rank test and Cox regression analysis were used to elucidate the impact of the Hyams grades on recurrence-free survival (RFS), metastasis-free survival (MFS), and overall survival (OS) of ENB patients. RESULTS We included 33 studies with 492 ENB patients. We found significant associations of Kadish stages, Dulguerov stages, rates of recurrence, metastasis, and patient mortality with Hyams grade. Log-rank tests and Cox regression models demonstrated significant differences in RFS and OS of Hyams grade I - II, grade III, and grade IV patients. There was no statistical difference in RFS and OS of Hyams grade I and II. Radiotherapy was only effective in grade III - IV ENBs and chemotherapy showed no benefits to patients. CONCLUSION We verify that the Hyams grading system appears to be a reliable prognostic indicator to assess ENB patient outcomes. Consolidating the Hyams grading system into a three-tier system based on similar clinical outcomes of grades I and II may simplify this classification schema.
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22
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Kumar P, Sundriyal D, Bhandari R, Singh A, Jat B, Sehrawat A. Facial disfigurement due to olfactory neuroblastoma: beauty regained with chemotherapy. Cancer Rep (Hoboken) 2021. [DOI: https:/doi.org/10.1002/cnr2.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Parmod Kumar
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Deepak Sundriyal
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Rekha Bhandari
- Department of Pathology All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Abhijeet Singh
- Department of Head and Neck Surgery All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Bhinyaram Jat
- Department of Head and Neck Surgery All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Amit Sehrawat
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh Uttarakhand India
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23
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Kumar P, Sundriyal D, Bhandari R, Singh A, Jat B, Sehrawat A. Facial disfigurement due to olfactory neuroblastoma: beauty regained with chemotherapy. Cancer Rep (Hoboken) 2021; 4:e1303. [PMID: 33029949 PMCID: PMC7941440 DOI: 10.1002/cnr2.1303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Olfactory neuroblastoma (ONB) is a sinonasal malignancy seldom seen in clinical practice. It is also known by various other names like esthesioneuroblastoma, esthesioneuroepithelioma, esthesioneurocytoma, and esthesioneuroma. Surgery and radiation therapy are considered as standard treatment modalities for ONB; however, the role of chemotherapy is not well established. AIMS We aim to define the role of chemotherapy in the neoadjuvant setting in a case of ONB. METHODS AND RESULTS We report a young female patient presenting with a naso-facial swelling causing facial disfigurement, proptosis, decreased visual acuity, and poor performance status. She was diagnosed with advanced-stage ONB. Prompt administration of chemotherapy led to the improvement in the symptoms and rapid regression of the tumor mass. Later on, the tumor mass was excised completely without any neurological deficit. CONCLUSION This report justifies the role of neoadjuvant chemotherapy in the management of ONB.
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Affiliation(s)
- Parmod Kumar
- Department of Medical Oncology, HematologyAll India Institute of Medical SciencesRishikeshUttarakhandIndia
| | - Deepak Sundriyal
- Department of Medical Oncology, HematologyAll India Institute of Medical SciencesRishikeshUttarakhandIndia
| | - Rekha Bhandari
- Department of PathologyAll India Institute of Medical SciencesRishikeshUttarakhandIndia
| | - Abhijeet Singh
- Department of Head and Neck SurgeryAll India Institute of Medical SciencesRishikeshUttarakhandIndia
| | - Bhinyaram Jat
- Department of Head and Neck SurgeryAll India Institute of Medical SciencesRishikeshUttarakhandIndia
| | - Amit Sehrawat
- Department of Medical Oncology, HematologyAll India Institute of Medical SciencesRishikeshUttarakhandIndia
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Roytman M, Tassler AB, Kacker A, Schwartz TH, Dobri GA, Strauss SB, Capalbo AM, Magge RS, Barbaro M, Lin E, Osborne JR, Jana Ivanidze. [68Ga]-DOTATATE PET/CT and PET/MRI in the diagnosis and management of esthesioneuroblastoma: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2058. [PMID: 35854930 PMCID: PMC9241319 DOI: 10.3171/case2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare sinonasal neuroectodermal malignancy with a slow onset of symptoms, favorable 5-year survival, and a propensity for delayed locoregional recurrence. Current treatment options include resection, adjuvant radiotherapy, and/or chemotherapy; however, because of its rarity and location, determining the optimal treatment for ENB has been challenging. OBSERVATIONS ENBs strongly express somatostatin receptors (SSTRs), particularly SSTR2, providing a molecular target for imaging and therapy. LESSONs The authors present a case series of ENBs imaged with [68Ga]-DOTATATE PET/MRI and PET/CT and discuss the emerging role of [68Ga]-DOTATATE PET for ENB diagnosis, staging, and treatment response monitoring.
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Affiliation(s)
| | | | | | | | | | | | | | - Rajiv S. Magge
- Neuro-Oncology, Weill Cornell Medicine, New York, New York
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Wu K, Avila SA, Bhuyan R, Matloob A, Del Signore AG, Hadjipanayis C, Chelnis J. Orbital invasion by Esthesioneuroblastoma: a comparative case series and review of literature. Orbit 2020; 41:1-14. [PMID: 33317383 DOI: 10.1080/01676830.2020.1852262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To review the current literature on esthesioneuroblastoma (ENB) as it pertains to clinical features, grading systems, treatment options, and survival.Methods: A literature search in PubMed was performed to include all articles published in English with orbit involving ENB. Only articles that included each patient's demographics, tumor stage, treatment, or survival were included. A total of 22 articles with 104 patients were considered for this literature review. We also present five cases of ENB, all encountered in our health system, between 2010 and 2020.Results: The median age of diagnosis of orbit involving ENB was 44.5 years. Males were more likely affected than females at 72.9%. Common presenting ocular symptoms were visual change (38.1%), periorbital pain (33.3%), and diplopia (14.3%). Common clinical exam findings were proptosis (47.6%), extraocular movement deficit (23.8%), and periorbital edema (19.0%). Twenty-seven patients (77.1%) received surgery, 22 patients (62.9%) received chemotherapy, and 30 patients (85.7%) received radiation therapy as part of their treatment. Median duration of survival was 124.0 months and 5-year overall survival (OS) was 67.1%. Hyams, Kadish, and Dulguerov T-staging showed inconsistent survival prognosis while orbital invasion and lymph node metastasis had worse outcomes. Our five cases exhibited the spectrum of disease processes evidenced above, with four involving the orbit.Conclusions: ENB is a rare sinonasal tumor that can invade the orbit. Because of its rarity, no single staging system appears superior. Resection with radiation therapy has superior survival results while the benefits of chemotherapy are currently unknown.
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Affiliation(s)
- Kevin Wu
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah A Avila
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rupak Bhuyan
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ammar Matloob
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - James Chelnis
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sun M, Wang K, Qu Y, Zhang J, Zhang S, Chen X, Wang J, Wu R, Zhang Y, Yi J, Xiao J, Xu G, Huang X, Luo J. Proposal of a TNM classification-based staging system for esthesioneuroblastoma: More precise prediction of prognosis. Head Neck 2020; 43:1097-1104. [PMID: 33301222 DOI: 10.1002/hed.26559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/01/2020] [Accepted: 11/20/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Esthesioneuroblastoma (ENB) is a rare malignant neoplasm. Currently, no consistent and universal staging system for ENB exists. The aim of this study is to propose a TNM-based classification. SUBJECTS AND METHODS Hundred and forty-two patients from our institution, with ENB pathologically confirmed between July 1978 and December 2018, were reviewed. All patients were restaged according to the Kadish stage, Morita stage and American Joint Committee on Cancer (AJCC) T classification from clinical and radiological data. Multivariate Cox proportional hazard regression analyses were performed to determine the impact of various factors. The goodness-of-fit and predictive accuracy of the different staging systems were calculated using R software. RESULTS The median follow-up time was 57 months (range: 4-229 months). According to the Kadish system, the 5-year overall survival (OS) for patients with stage A, B and C was 100%, 83.6% and 64.2%, respectively (P = .055). With respect to the Morita classification, 5-year OS for stages A, B, C and D was 100%, 83.6%, 70.7% and 50.0%, respectively (P = .004). Analysis based on the proposed staging model demonstrated 5-year OS for stage I, II, III and IV disease was 100%, 88.9%, 75.9% and 49.0%, respectively (P < .001). In separate multivariate Cox regression models, only the novel staging system exhibited independent effects on OS (P = .004); the Akaike information criterion and Harrell's concordance index were also superior to those calculated for the Kadish or Morita systems. CONCLUSIONS The proposed TNM-based staging system offers an improved prognostic assessment for patients with ENB. Further verification and refinement from additional dataset application is required.
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Affiliation(s)
- Meng Sun
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianghu Zhang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shiping Zhang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesong Chen
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guozhen Xu
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Anderson EM, Luu M, Balzer BL, Scher KS, Mita AC, Lu DJ, Shiao SL, Clair JMS, Ho AS, Zumsteg ZS. Variations in the association of grade with survival across the head and neck cancer landscape. Head Neck 2020; 43:1105-1115. [PMID: 33300641 DOI: 10.1002/hed.26566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although pathologic tumor grade is a well-established prognostic risk factor that impacts staging and treatment decisions across multiple cancer types, its role in head and neck squamous cell carcinoma (HNSCC) is less certain. METHODS HNSCC patients diagnosed from 2010 to 2015 and undergoing primary surgery in the National Cancer Data Base were identified. Propensity score matching and multivariable Cox regression were performed. RESULTS Among 27 041 HNSCC patients, 13 941 had oral cavity cancers (OCC). Intermediate-grade (hazard ratio [HR] 1.16, 95% CI 1.07-1.26, P < .001) and high-grade (HR 1.38, 95% CI 1.26-1.52, P < .001) tumors had worse survival than low-grade tumors. This magnitude was comparable to other well-established prognostic factors, including margin positivity, extranodal extension, and lymphovascular invasion. By contrast, there was no association between grade and survival in larynx/hypopharynx or HPV(-) oropharynx cancer. CONCLUSIONS The prognostic impact of pathologic grade is highly variable across head and neck subsites and is the strongest among OCC patients.
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Affiliation(s)
- Eric M Anderson
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael Luu
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Bonnie L Balzer
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kevin S Scher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Tower Hematology Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alain C Mita
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Diana J Lu
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Stephen L Shiao
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Zhou Q, Li Z, Liu B, Zhao L, Tian B, Wang L, Xi Y. Occult olfactory neuroblastoma presenting with multiple bone metastases: a case report. Medicine (Baltimore) 2020; 99:e22630. [PMID: 33235061 PMCID: PMC7710244 DOI: 10.1097/md.0000000000022630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONABLE Olfactory neuroblastoma (ONB) is a rare malignant tumor of the nasal cavity, the primary local symptoms are usually inconspicuous. Patients are often admitted to various specialties based on different primary symptoms, which may result in delayed diagnosis and even a misdiagnosis. PATIENT CONCERNS Here we report a case of ONB that presented initially as multiple ostealgia without any local symptoms of the tumor and primarily misdiagnosed as multiple myeloma. The patient was a 47-year-old female with bone pain at multiple sites. The initial diagnosis was considered as multiple myeloma. However, the morphologic examination of bone marrow suggested that the tumor cells originated from the nervous tissues. After the positron emission computed tomography scan, the primary lesion in the nasal cavity was located, and a biopsy was performed. DIAGNOSIS The final diagnosis of ONB was confirmed by histopathological tests. INTERVENTIONS The patient was treated with metronomic chemotherapy. OUTCOMES The symptoms of bone pain were significantly relieved 3 months later. The emission computed tomography scan of the whole body bones and the magnetic resonance imaging of the head showed that the tumor size did not change significantly and proved a progression-free of the disease. LESSONS It is a reasonable strategy to identify the original latent tumor by a prompt positron emission computed tomography scan when the primary diagnosis indicates a metastatic disease, especially for the occult malignancies like ONB.
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Affiliation(s)
- Qi Zhou
- The First Clinical Medical College, Lanzhou University
| | - Zijian Li
- Department of Hematology, The First Hospital of Lanzhou University
| | - Bei Liu
- Department of Hematology, The First Hospital of Lanzhou University
| | - Long Zhao
- Department of Hematology, The First Hospital of Lanzhou University
| | - Baohong Tian
- Department of Oncology, Donggang Branch of The First Hospital of Lanzhou University
| | - Lina Wang
- Department of Hematology, The First Hospital of Lanzhou University
| | - Yaming Xi
- Department of Hematology, The First Hospital of Lanzhou University
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Goshtasbi K, Birkenbeuel JL, Abouzari M, Lehrich BM, Yasaka TM, Abiri A, Muhonen EG, Hsu FPK, Kuan EC. Short-Term Morbidity and Predictors of Adverse Events Following Esthesioneuroblastoma Surgery. Am J Rhinol Allergy 2020; 35:500-506. [PMID: 33121257 DOI: 10.1177/1945892420970468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The short-term adverse events and predictors of morbidity in surgical resection of esthesioneuroblastoma (ENB) are largely unknown, and investigating these variables can help direct planning for at-risk patients. METHODS The 2005-2017 National Surgical Quality Improvement Program database was queried to identify patients with a diagnosis of ENB undergoing skull base surgery for tumor resection. Information regarding demographics, patient morbidity score, pre-operative and intra-operative data, and post-operative outcomes were extracted. Cox proportional hazard analysis was utilized to assess complication and readmission/reoperation rates. RESULTS A total of 95 patients undergoing skull base surgery for resection of ENB were included. Mean age, BMI, operation time, and post-operative length of stay (LOS) of the cohort were 53.6 ± 16.2 years, 29.1 ± 6.5, 392.0 ± 204.6 minutes, and 5.8 ± 4.6 days, respectively. In total, 31 patients (32.6%) experienced at least one 30-day adverse event, which included blood transfusion intra-operatively or within 72 hours from the operation (22.1%), readmission (10.7%), intubation >48 hours (7.4%), reintubation (4.2%), organ or space infection (4.2%), reoperation (4.0%), superficial or deep surgical site infection (2.1%), sepsis (2.1%), pulmonary embolism (1.1%), and myocardial infarction (1.1%). Patients who experienced at least one adverse event had significantly higher operation time (486.8 ± 230.4 vs. 347.5 ± 176.2 minutes, p = 0.002), LOS (9.2 ± 5.6 days vs. 4.2 ± 3.0, p < 0.001), and lower hematocrit (37.3 ± 5.9 vs. 41.2 ± 3.8, p < 0.001) and albumin levels (3.8 ± 0.6 vs. 4.2 ± 0.3, p = 0.009). Patients with a higher American Society of Anesthesiologists (ASA) score (HR = 2.39; p = 0.047) or longer operation time (HR = 1.004; p = 0.001) had a significantly higher risk for experiencing adverse events. Obesity was not associated with different intra- or post-operative outcomes, but older patients had shorter operations (p = 0.002) and LOS (p = 0.0014). CONCLUSION Longer operation time and lower pre-operative hematocrit and albumin levels may all increase complication rates in ENB resection. Patients with high ASA score or more advanced age may have different short-term outcomes.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Tyler M Yasaka
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Ethan G Muhonen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, California
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
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Jiang L, Lin T, Zhang Y, Gao W, Deng J, Xu Z, Luo X, Huang Z, Chen F, Shi J, Lai Y. A novel nomogram to predict the overall survival in esthesinoeroblastoma. BMC Cancer 2020; 20:993. [PMID: 33054751 PMCID: PMC7556920 DOI: 10.1186/s12885-020-07435-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/17/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Increasing evidence indicates that the pathology and the modified Kadish system have some influence on the prognosis of esthesioneuroblastoma (ENB). However, an accurate system to combine pathology with a modified Kadish system has not been established. METHODS This study aimed to set up and evaluate a model to predict overall survival (OS) accurately in ENB, including clinical characteristics, treatment and pathological variables. We screened the information of patients with ENB between January 1, 1976, and December 30, 2016 from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program as a training cohort. The validation cohort consisted of patients with ENB at Sun Yat-sen University Cancer Center and The First Affiliated Hospital of Sun Yat-sen University in the same period, and 87 patients were included. The Pearson's chi-squared test was used to assess significance of clinicopathological and demographic characteristics. We used the Cox proportional hazards model to examine univariate and multivariate analyses. The model coefficients were used to calculate the Hazard ratios (HR) with 95% confidence intervals (CI). Prognostic factors with a p-value < 0.05 in multivariate analysis were included in the nomogram. The concordance index (c-index) and calibration curve were used to evaluate the predictive power of the nomogram. RESULTS The c-index of training cohort and validation cohort are 0.737 (95% CI, 0.709 to 0.765) and 0.791 (95% CI, 0.767 to 0.815) respectively. The calibration curves revealed a good agreement between the nomogram prediction and actual observation regarding the probability of 3-year and 5-year survival. We used a nomogram to calculate the 3-year and 5-year growth probability and stratified patients into three risk groups. CONCLUSIONS The nomogram provided the risk group information and identified mortality risk and can serve as a reference for designing a reasonable follow-up plan.
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Affiliation(s)
- Lijie Jiang
- The Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangzhou, 510080, P.R. China
| | - Tengjiao Lin
- Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yu Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Wenxiang Gao
- The Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangzhou, 510080, P.R. China
| | - Jie Deng
- The Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangzhou, 510080, P.R. China
| | - Zhaofeng Xu
- The Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangzhou, 510080, P.R. China
| | - Xin Luo
- The Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangzhou, 510080, P.R. China
| | - Zhaoqi Huang
- The Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangzhou, 510080, P.R. China
| | - Fenghong Chen
- The Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangzhou, 510080, P.R. China
| | - Jianbo Shi
- The Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangzhou, 510080, P.R. China
| | - Yinyan Lai
- The Otorhinolaryngology Hospital, First Affiliated Hospital of Sun Yat-sen University, No.58 Zhongshan Er Road, Guangzhou, Guangzhou, 510080, P.R. China.
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Kumar P, Sundriyal D, Bhandari R, Singh A, Jat B, Sehrawat A. Facial disfigurement due to olfactory neuroblastoma: beauty regained with chemotherapy. Cancer Rep (Hoboken) 2020. [DOI: https://doi.org/10.1002/cnr2.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Parmod Kumar
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Deepak Sundriyal
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Rekha Bhandari
- Department of Pathology All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Abhijeet Singh
- Department of Head and Neck Surgery All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Bhinyaram Jat
- Department of Head and Neck Surgery All India Institute of Medical Sciences Rishikesh Uttarakhand India
| | - Amit Sehrawat
- Department of Medical Oncology, Hematology All India Institute of Medical Sciences Rishikesh Uttarakhand India
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Liu T, Sun Q, Qin W, Chen X, Hu Q. Outcome and Optimal Treatment for Esthesioneuroblastoma in the Era of Intensity-Modulated Radiation Therapy: A Single-Center Experience. Cancer Manag Res 2020; 12:8355-8362. [PMID: 32982429 PMCID: PMC7490047 DOI: 10.2147/cmar.s259921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Esthesioneuroblastoma (ENB) is a type of rare malignant neoplasm of the sinonasal cavity. Optimal treatment for ENB is still controversial. A retrospective study was conducted to identify the clinical outcome and optimal treatment for ENB in the era of intensity-modulated radiation therapy (IMRT). Patients and Methods Between December 2006 and August 2018, 37 patients with ENB without distant metastasis who underwent neoadjuvant chemotherapy followed by chemoradiotherapy (C+RC) or surgery followed by radiotherapy or chemoradiotherapy (S+R/RC) were retrospectively reviewed at our center. Results The median follow-up period was 63.7 months (range, 13.2-111.5 months). Five-year overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were similar between treatment arms (P values > 0.05). With a multivariate analysis, a Karnofsky Performance Status (KPS) of ≤80 was a prognostic factor for poor five-year OS. A KPS of ≤80 and Kadish class C-D tumors were prognostic factors for poor PFS. A KPS of ≤80 was a prognostic factor for poor LRFS. When KPS was ≤80 and tumors were Kadish class C-D, T3-4 and N1 were prognostic factors for poor DMFS. Subgroup analyses also demonstrated that the two treatment arms exhibited similar trends for OS, PFS, LRFS, and DMFS, excluding patients with N1 or Kadish class A-B tumors (P values > 0.05). Conclusion In the era of IMRT, S+R/RC failed to improve the outcomes of patients with ENB. C+RC may be a feasible treatment option for patients with ENB.
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Affiliation(s)
- Tongxin Liu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People's Republic of China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Quanquan Sun
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People's Republic of China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Weifeng Qin
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People's Republic of China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Xiaozhong Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People's Republic of China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Qiaoying Hu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People's Republic of China.,Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China
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Long-term analysis of multimodality treatment outcomes and prognosis of esthesioneuroblastomas: a single center results of 138 patients. Radiat Oncol 2020; 15:219. [PMID: 32948223 PMCID: PMC7501706 DOI: 10.1186/s13014-020-01667-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Background The aim of this study is to evaluate the efficacy of different treatment strategies and the potential prognostic factors of esthesioneuroblastoma (ENB). Materials and methods Between April 1984 and December 2018, 138 patients with non-metastatic ENB were retrospectively analyzed. The treatment modalities mainly included surgery alone (n = 7), radiotherapy alone (n = 33), concurrent chemoradiotherapy (n = 17), surgery combined with current chemoradiotherapy (n = 32), and surgery plus radiotherapy (n = 49). Results The median follow-up time for the entire cohort was 61 months (range, 4–231 months). The 5-year overall survival (OS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS) rate were 69.6, 78.0 and 73.9%, respectively. Surgery combined with radiotherapy elicited superior survival results, and the combination of surgery and current chemoradiotherapy achieved the best prognoses for all patients, patients with advanced Kadish disease, patients receiving intensity modulated radiation therapy and those with positive surgical margin. Univariate analysis identified orbital invasion and treatment modalities were predictors for OS, LRFFS and DMFS. Lymph node metastasis was associated with OS and DMFS, but not LRFFS. Intracranial invasion, advanced Kadish stage and not receiving concurrent chemotherapy were also predictive of lower OS. Multivariate analyses indicated that lymph node metastasis was an independent prognostic factor affecting DMFS, whereas treatment modalities was independent prognostic factors for OS and LRFFS. Conclusion Orbital invasion, intracranial invasion, lymph node metastasis and advanced Kadish disease at initial diagnosis were significantly associated with inferior prognosis. Regarding the treatment modality, the optimal strategy remined surgery with radiotherapy-based multimodality treatment. The concurrent chemoradiotherapy may play a more beneficial role.
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Dumont B, Lemelle L, Cordero C, Couloigner V, Bernard S, Cardoen L, Brisse HJ, Jehanno N, Fréneaux P, Helfre S, Rouffiange L, Réguerre Y, Orbach D. Esthesioneuroblastoma in children, adolescents and young adults. Bull Cancer 2020; 107:934-945. [PMID: 32896369 DOI: 10.1016/j.bulcan.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022]
Abstract
The esthesioneuroblastoma (ENB) is characterized as a rare malignant sinonasal tumor of neuroectodermal origin. Its starting point is the olfactory epithelium located in the upper part of the nasal cavities. Different nomenclatures have been proposed, but the most common are "esthesioneuroblastoma" and "olfactory neuroblastoma". ENBs have a bimodal distribution and mainly occur in teenagers, young adults and people aged 50-60. It is a very rare tumor in pediatrics since only around 100 cases have been reported so far. Within ENBs, we can distinguish tumors with different biological behavior ranging from localized forms with slow evolution to aggressive and metastatic forms at onset. In addition, precisely diagnosing undifferentiated tumors and distinguishing them from other etiologies of sinonasal tumors are sometime difficult. Added to its very low incidence, these characteristics make the study of ENB complicated. The standard treatment currently includes broad surgery followed by radiation therapy in localized resectable tumors. Neoadjuvant chemotherapy is indicated in large unresectable tumors and in metastatic forms. However, in certain indications, such as high-grade operable tumors, the role of perioperative chemotherapy remains to be defined. The objective of this analysis is to detail current knowledge regarding ENBs' epidemiological, biological, clinical and radiological characteristics as well as how to manage ENB in young patients.
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Affiliation(s)
- Benoit Dumont
- PSL research university, Institut Curie, SIREDO oncology center (care, innovation and research for children and AYA with cancer), Paris, France.
| | - Lauriane Lemelle
- PSL research university, Institut Curie, SIREDO oncology center (care, innovation and research for children and AYA with cancer), Paris, France
| | - Camille Cordero
- PSL research university, Institut Curie, SIREDO oncology center (care, innovation and research for children and AYA with cancer), Paris, France
| | - Vincent Couloigner
- Assistance publique-Hôpitaux de Paris, hôpital Necker-Enfants malades, department of head and neck surgery, Paris, France
| | - Sophie Bernard
- Assistance publique-Hôpitaux de Paris, hôpital Robert-Debré, department of head and neck surgery, Paris, France
| | | | - Hervé J Brisse
- Institut Curie, department of medical imaging, Paris, France
| | - Nina Jehanno
- Institut Curie, department of nuclear medicine, Paris, France
| | - Paul Fréneaux
- Institut Curie, department of diagnostic and theranostic medicine, Paris, France
| | - Sylvie Helfre
- Institut Curie, department of radiotherapy, Paris, France
| | - Lucie Rouffiange
- PSL research university, Institut Curie, SIREDO oncology center (care, innovation and research for children and AYA with cancer), Paris, France
| | - Yves Réguerre
- CHU de Saint-Denis, pediatric oncology and hematology unit, Saint-Denis, La Reunion, France
| | - Daniel Orbach
- PSL research university, Institut Curie, SIREDO oncology center (care, innovation and research for children and AYA with cancer), Paris, France
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Moschettoni L, Ruggiero F, Fava FM, De Luna A, Lunardi P. Late Intramedullary Spinal Metastases from Esthesioneuroblastoma: Case Report and Prognostic Implications. World Neurosurg 2020; 145:183-186. [PMID: 32818694 DOI: 10.1016/j.wneu.2020.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB) is an uncommon neuroectodermal tumor that originates from the olfactory mucosa and often recurs locally. Distant metastases of ENB have been described, but there are few reports of intramedullary metastases to the spinal cord. CASE DESCRIPTION Here we report a case of a patient presenting with a progressive paraparesis and magnetic resonance imaging findings of multiple drop metastases to thoracic and lumbar regions of the spinal cord, 17 years after diagnosis and treatment for an intracranial ENB with subsequent neck nodal metastases. The dorsal symptomatic lesion was treated with resection, radiotherapy, and adjuvant chemotherapy. The implications of spinal metastases for the clinical prognosis of this disease are discussed, with a review of the few reported cases of spinal ENB metastases in the literature. CONCLUSIONS Through the presentation of this case we hope to further contribute to a better understanding of this rare disease's prognosis.
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Affiliation(s)
- Laura Moschettoni
- Department of Neurosurgery, University of Rome "Tor Vergata", Rome, Italy.
| | - Francesca Ruggiero
- Department of Neurosurgery, University of Rome "Tor Vergata", Rome, Italy
| | - Filippo Maria Fava
- Department of Neurosurgery, University of Rome "Tor Vergata", Rome, Italy
| | - Adolfo De Luna
- Department of Neurosurgery, University of Rome "Tor Vergata", Rome, Italy
| | - Pierpaolo Lunardi
- Department of Neurosurgery, University of Rome "Tor Vergata", Rome, Italy
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Bao C, Hu W, Hu J, Dong Y, Lu JJ, Kong L. Intensity-Modulated Radiation Therapy for Esthesioneuroblastoma: 10-Year Experience of a Single Institute. Front Oncol 2020; 10:1158. [PMID: 32766154 PMCID: PMC7379860 DOI: 10.3389/fonc.2020.01158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate efficacy and safety of intensity-modulated radiotherapy (IMRT) in the management of esthesioneuroblastoma (ENB). Methods and Materials: A retrospectively analysis of 52 ENB patients treated with IMRT between 8/2008 and 8/2018 was performed. Thirteen of the 44 patients (29.5%) with newly diagnosed and 2 of the 8 patients with recurrent disease presented regional lymph node metastasis. The median dose of IMRT was 66 (range 52.5-75) Gy for all patients. Elective nodal irradiation (ENI) was provided to all excluding 6 patients in this cohort. Results: With a median follow-up time of 32.5 (6~121) months, the 3-year overall survival (OS), progression-free survival (PFS), local progression-free survival (LPFS), regional progression-free survival (RPFS), and distant metastasis-free survival (DMFS) rates for the entire cohort were 89.7, 69.5, 89.7, 95.1, and 85.4%, respectively. Multivariate analysis revealed that N-classification (N- vs. N+) at presentation was the only significant prognosticators for PFS. No significant prognosticator was identified for other survival outcome. No severe (i.e., grade 3 or 4) IMRT-induced acute toxicity was observed. Severe late toxicities were infrequent (11.5%), which included dysosmia (3.8%), hearing loss (3.8%), radiation brain injury (1.9%), and temporal lobe necrosis (1.9%). Moreover, late ocular toxicity secondary to IMRT was not observed. Conclusion: IMRT produced acceptable 3-year outcomes in terms of OS (89.7%), LPFS (89.7%), and RPFS (95.1%) rates without substantial late adverse effects. Further investigations for a more effective systemic strategy for distant disease control as well as a precision radiation technique for further improvement in local control are needed.
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Affiliation(s)
- Cihang Bao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Weixu Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jiyi Hu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yuanli Dong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jiade J Lu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Lin Kong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
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Abstract
PURPOSE OF REVIEW Sinonasal cancers are a heterogenous group of rare cancers for which histopathological diagnosis can be very challenging and treatment options are limited for advanced disease in particular. Here, we review the candidacy of novel diagnostic and prognostic biomarkers, and therapeutic targets for sinonasal cancers. RECENT FINDINGS Molecular multidimensional analyses of sinonasal cancers have been lagging behind other major cancers, but there are numerous publications describing the discovery of novel candidate biomarkers, e.g. the methylation classifier, originally developed for brain cancers, and gene expression panels for the prediction of response to induction chemotherapy in sinonasal undifferentiated carcinoma. The most promising biomarkers are summarized and discussed further with regard to their clinical applicability and future potential. Many of the described novel biomarkers for sinonasal cancers will eventually overcome the pitfalls associated with the frequently non-specific immunohistological tests. With comprehensive, multidimensional molecular testing of these tumours in collaborative consortia projects, our better understanding of the molecular mechanisms of sinonasal cancers and their carcinogenesis will determine the most useful diagnostic and prognostic biomarkers, allow stringent multi-institutional validation and guide trials on targeted therapies.
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, 72 Huntley Street, London, UK
- Royal London Hospital, Barts Health NHS Trust, London, UK
- Royal National Throat, Nose and Ear Hospital/Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jacklyn Liu
- UCL Cancer Institute, University College London, 72 Huntley Street, London, UK
- Royal National Throat, Nose and Ear Hospital/Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital/Head and Neck Centre, University College London Hospitals NHS Foundation Trust, London, UK.
- UCL Ear Institute, University College London, London, UK.
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Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND, Bettag M, Bleier BS, Cappabianca P, Carrau RL, Casiano RR, Cavallo LM, Ebert CS, El-Sayed IH, Evans JJ, Fernandez-Miranda JC, Folbe AJ, Froelich S, Gentili F, Harvey RJ, Hwang PH, Jane JA, Kelly DF, Kennedy D, Knosp E, Lal D, Lee JYK, Liu JK, Lund VJ, Palmer JN, Prevedello DM, Schlosser RJ, Sindwani R, Solares CA, Tabaee A, Teo C, Thirumala PD, Thorp BD, de Arnaldo Silva Vellutini E, Witterick I, Woodworth BA, Wormald PJ, Snyderman CH. ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 2020; 9:S145-S365. [PMID: 31329374 DOI: 10.1002/alr.22326] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam J Folbe
- Michigan Sinus and Skull Base Institute, Royal Oak, MI
| | | | | | - Richard J Harvey
- University of Toronto, Toronto, Canada.,University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles Teo
- Prince of Wales Hospital, Randwick, Australia
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Mehta GU, Raza SM, Su SY, Hanna EY, DeMonte F. Management of olfactory neuroblastoma, neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma involving the skullbase. J Neurooncol 2020; 150:367-375. [PMID: 32424573 DOI: 10.1007/s11060-020-03537-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sinonasal tumors that harbor neuroendocrine histologic features include olfactory neuroblastoma (previously known as esthesioneuroblastoma), sinonasal neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma. These tumors represent a diverse spectrum of clinical behavior and as such require histology-specific management. Herein, we review the management of these sinonasal tumors with neuroendocrine features and discuss fundamentals of multi-modality care for each histology. An emphasis is placed on olfactory neuroblastomas, given their relative frequency and skullbase origin. METHODS A comprehensive literature review on contemporary management of olfactory neuroblastoma, sinonasal neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma was performed. RESULTS Management of sinonasal tumors with neuroendocrine features can include surgical resection, radiation therapy, and/or chemotherapy. Due to their site of origin, these tumors can frequently involve the skullbase, which can require site-specific care. The optimal treatment modalities and the sequence in which they are performed are largely dependent on histology. In most cases, olfactory neuroblastoma is best managed with surgical resection followed by radiation therapy. Sinonasal neuroendocrine carcinomas represent a variety of histologic phenotypes (carcinoid, atypical carcinoid, small cell, and large cell), which determine the optimal treatment modality. Finally, sinonasal undifferentiated carcinoma is likely best managed by induction chemotherapy with subsequent therapy dictated by the initial response. CONCLUSIONS A team approach to multi-modality care is essential in the treatment of olfactory neuroblastoma, sinonasal neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma. Early biopsy, histologic diagnosis, and comprehensive imaging are critical to determining the appropriate management paradigm.
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Affiliation(s)
- Gautam U Mehta
- Division of Neurosurgery, House Clinic, Los Angeles, CA, USA
| | - Shaan M Raza
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. .,Department of Neurosurgey, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Blvd, Room FC7.200, Unit 442, Houston, TX, 77030-4009, USA.
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Dumont B, Fresneau B, Claude L, Defachelles AS, Couloigner V, Puget S, Brisse HJ, Fréneaux P, Lacour B, Orbach D. Pattern of loco-regional relapses and treatment in pediatric esthesioneuroblastoma: The French very rare tumors group (Fracture) contribution. Pediatr Blood Cancer 2020; 67:e28154. [PMID: 31930719 DOI: 10.1002/pbc.28154] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB) is a rare neuroectodermal tumor that seldom occurs during childhood. Multimodal treatments are currently proposed, but the place of each therapy is still in debate. Our objective is to describe clinical evolution, especially the pattern of relapses and determine contributors to tumor progression. PROCEDURE Medical charts of all children (≤18 years) affected by ENB treated in France from January 1990 to December 2015 were retrospectively analyzed. RESULTS Eighteen patients were selected (10 males). Median age at diagnosis was 12.2 years (0.9-18). Tumor extension was Kadish stage A (n = 1), B (n = 3), C (n = 10), and D (n = 4). Hyams histological grades were I (n = 1), II (n = 3), III (n = 6), and IV (n = 6) (in two cases not defined). Initial cervical nodal spread was assessed by magnetic resonance imaging (n = 15), computed tomography scan (n = 16), fluorodeoxyglucose-positron emission tomography-computed tomography (n = 7), and cytological/histological analysis (n = 2). N1 stage was confirmed by imaging in two of 18 cases and one of two cases had cervical node dissection with neck irradiation (58 Gy). After a median follow-up of survivors of 7.6 years (3.8-17.9), 10 patients developed neuromeningeal progression, whereas no cervical nodal relapse occurred and only eight survived. Both 5-year overall and event-free survival rates were 44.4% (±11.7%). CONCLUSIONS The poor prognosis is mainly related to neuromeningeal dissemination that should be considered during treatment strategy. However, cervical lymph node relapse is rare.
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Affiliation(s)
- Benoît Dumont
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - Brice Fresneau
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Line Claude
- Department of Radiation Oncology, Léon Bérard Center, Lyon, France
| | | | - Vincent Couloigner
- Pediatric Head and Neck Surgery and Otorhinolaryngology Department, Necker Enfants-Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphanie Puget
- Pediatric Neurosurgery Department, Necker Enfants-Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Paul Fréneaux
- Department of Biopathology, Institut Curie, Paris, France
| | - Brigitte Lacour
- National Registry of Childhood Solid Tumors, CHU de Nancy, Vandœuvre-lès-Nancy, France.,Inserm U1153, Center of Research in Epidemiology and Statistics (CRESS), Paris University, Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Paris, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
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Hasan OK, Ravi Kumar AS, Kong G, Oleinikov K, Ben-Haim S, Grozinsky-Glasberg S, Hicks RJ. Efficacy of Peptide Receptor Radionuclide Therapy for Esthesioneuroblastoma. J Nucl Med 2020; 61:1326-1330. [DOI: 10.2967/jnumed.119.237990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/10/2020] [Indexed: 11/16/2022] Open
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Anzai Y. ADC on Diffusion Imaging: The MR Analog of SUV on FDG‐PET: Perfect Is the Enemy of Good. J Magn Reson Imaging 2020; 51:286-287. [DOI: 10.1002/jmri.26938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
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Classe M, Yao H, Mouawad R, Creighton CJ, Burgess A, Allanic F, Wassef M, Leroy X, Verillaud B, Mortuaire G, Bielle F, Le Tourneau C, Kurtz JE, Khayat D, Su X, Malouf GG. Integrated Multi-omic Analysis of Esthesioneuroblastomas Identifies Two Subgroups Linked to Cell Ontogeny. Cell Rep 2019; 25:811-821.e5. [PMID: 30332658 DOI: 10.1016/j.celrep.2018.09.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/18/2018] [Accepted: 09/12/2018] [Indexed: 12/23/2022] Open
Abstract
Esthesioneuroblastoma (ENB) is a rare cancer of the olfactory mucosa, with no established molecular stratification to date. We report similarities of ENB with tumors arising in the neural crest and perform integrative analysis of these tumors. We propose a molecular-based subtype classification of ENB as basal or neural, both of which have distinct pathological, transcriptomic, proteomic, and immune features. Among the basal subtype, we uncovered an IDH2 R172 mutant-enriched subgroup (∼35%) harboring a CpG island methylator phenotype reminiscent of IDH2 mutant gliomas. Compared with the basal ENB methylome, the neural ENB methylome shows genome-wide reprogramming with loss of DNA methylation at the enhancers of axonal guidance genes. Our study reveals insights into the molecular pathogenesis of ENB and provides classification information of potential therapeutic relevance.
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Affiliation(s)
- Marion Classe
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonnes-Universités, University Pierre and Marie Curie, Paris, France.
| | - Hui Yao
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Roger Mouawad
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonnes-Universités, University Pierre and Marie Curie, Paris, France
| | - Chad J Creighton
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Division of Biostatistics, Department of Medicine and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Alice Burgess
- Department of Otolaryngology-Head and Neck Surgery, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Diderot Paris VII, Paris, France
| | - Frederick Allanic
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonnes-Universités, University Pierre and Marie Curie, Paris, France
| | - Michel Wassef
- Department of Pathology, Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris-Diderot Paris VII, Paris, France
| | - Xavier Leroy
- Department of Pathology, CHRU de Lille, Université Lille 2, Lille, France
| | - Benjamin Verillaud
- Department of Otolaryngology-Head and Neck Surgery, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Université Paris-Diderot Paris VII, Paris, France
| | - Geoffrey Mortuaire
- Department of Otolaryngology-Head and Neck Surgery, CHRU de Lille, Université Lille 2, Lille, France
| | - Franck Bielle
- Department of Neuropathology Raymond Escourolle, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, 75013, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Saint-Cloud, France; INSERM U900 Research Unit, Saint-Cloud, France; Versailles-Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Jean-Emmanuel Kurtz
- Department of Hematology and Medical Oncology, CHRU Strasbourg, Hôpital Hautepierre, Strasbourg, France
| | - David Khayat
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonnes-Universités, University Pierre and Marie Curie, Paris, France
| | - Xiaoping Su
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gabriel G Malouf
- Department of Medical Oncology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonnes-Universités, University Pierre and Marie Curie, Paris, France; Department of Hematology and Medical Oncology, CHRU Strasbourg, Hôpital Hautepierre, Strasbourg, France; Institut Génomique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch-Graffenstaden, France.
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Schneider JR, Shatzkes DR, Scharf SC, Tham TM, Kulason KO, Buteau FA, Del Prete M, Chakraborty S, Anderson TA, Asiry S, Beauregard JM, Langer DJ, Costantino PD, Boockvar JA. Neuroradiological and Neuropathological Changes After 177Lu-Octreotate Peptide Receptor Radionuclide Therapy of Refractory Esthesioneuroblastoma. Oper Neurosurg (Hagerstown) 2019; 15:100-109. [PMID: 29554305 DOI: 10.1093/ons/opy028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Olfactory neuroblastoma, also known as esthesioneuroblastoma (ENB), is a malignant neoplasm with an unpredictable behavior. Currently, the widely accepted treatment is inductive chemotherapy, with or without surgery, followed by radiotherapy. Since data on genetics and molecular alterations of ENB are lacking, there is no standard molecularly targeted therapy. However, ENB commonly expresses the somatostatin receptor (SSTR) that is also expressed by neuroendocrine tumors. Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogues, such as 177Lu-octreotate, is an effective treatment for the latter. We present the complex neuroradiological and neuropathological changes associated with 177Lu-octreotate treatment of a patient with a highly treatment-resistant ENB. CLINICAL PRESENTATION A 60-yr-old male presented with an ENB that recurred after chemotherapy, surgery, stereotactic radiosurgery, and immunotherapy. Pathology revealed a Hyams grade 3 ENB and the tumor had metastasized to lymph nodes. Tumor SSTR expression was seen on 68Ga-octreotate positron emission tomography (PET)/computed tomography (CT), suggesting that PRRT may be an option. He received 4 cycles of 177Lu-octreotate over 6 mo, with a partial response of all lesions and symptomatic improvement. Four months after the last PRRT cycle, 2 of the lesions rapidly relapsed and were successfully resected. Three months later, 68Ga-octreotate PET/CT and magnetic resonance imaging indicate no progression of the disease. CONCLUSION We describe imaging changes associated with 177Lu-octreotate PRRT of relapsing ENB. To our knowledge, this is the first report describing neuropathological changes associated with this treatment. PRRT is a promising therapeutic option to improve the disease control, and potentially, the survival of patients with refractory ENB.
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Affiliation(s)
- Julia R Schneider
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Deborah R Shatzkes
- Department of Radiology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Stephen C Scharf
- Department of Nuclear Medicine, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Tristan M Tham
- Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Kay O Kulason
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | | | - Michela Del Prete
- Department of Medical Imaging, CHU de Québec-Université Laval, Quebec City, Canada
| | - Shamik Chakraborty
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Todd A Anderson
- Department of Pathology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Saeed Asiry
- Department of Pathology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | | | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Radiology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Peter D Costantino
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,Department of Otolaryngology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York, New York.,New York Head and Neck Institute, Zucker School of Medicine at Hofstra/Northwell, New York, New York
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Classe M, Burgess A, El Zein S, Wassef M, Herman P, Mortuaire G, Leroy X, Malouf GG, Verillaud B. Evaluating the prognostic potential of the Ki67 proliferation index and tumour-infiltrating lymphocytes in olfactory neuroblastoma. Histopathology 2019; 75:853-864. [PMID: 31306501 DOI: 10.1111/his.13954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 07/11/2019] [Indexed: 12/11/2022]
Abstract
AIMS Olfactory neuroblastomas (ONBs) are rare malignant tumours that arise in the nasal vault. To date, the Hyams grade remains the only widely used histological grading system. However, it is based only on morphological criteria, and has not been updated since 1988. The objective of this study was to explore the prognostic potential of the Ki67 proliferation index (PI) and tumour-infiltrating lymphocytes (TILs) in ONB. METHODS AND RESULTS A retrospective study was conducted on a bicentric series of 45 cases. The Ki67 PI was determined by counting at least 1000 nuclei on whole slides. TILs were evaluated with CD20, CD4 and CD8 immunohistochemical markers on whole slides. In this series, Hyams grades I, II, III and IV accounted for 13.4%, 44.4%, 20% and 22.2% of all cases, respectively. The Ki67 PI ranged from 1 to 93; the Ki67 PI was significantly higher in Hyams grade III-IV ONBs than in Hyams grade I-II ONBs (P < 0.0001). A Ki67 PI of ≥25 was associated with poorer survival (P = 0.02). TILs were present in both stromal and intratumoral compartments, but were located predominantly in the stromal component of the tumour. The numbers of intratumoral CD8+ cells/mm2 and CD4+ cells/mm2 were greater in high-grade ONBs than in low-grade ONBs (P = 0.0015 and P = 0.043, respectively). The numbers of T cells/mm2 and B cells/mm2 were not associated with survival, but a CD4/CD8 ratio of >2 was significantly associated with shorter survival (P = 0.04). CONCLUSION Our findings suggest that the Ki67 PI and TILs could be used as prognostic markers, as a potential alternative to the Hyams grade.
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Affiliation(s)
- Marion Classe
- Department of Pathology, Institut Gustave Roussy, Villejuif, France
| | - Alice Burgess
- Department of Otolaryngology - Head and Neck Surgery, Assistance Publique-Hopitaux de Paris, Lariboisière Hospital, Paris, France.,Faculty of Medicine, Paris Diderot University, Paris, France
| | - Sophie El Zein
- Department of Pathology, Assistance Publique-Hopitaux de Paris, Lariboisière Hospital, Paris, France
| | - Michel Wassef
- Department of Pathology, Assistance Publique-Hopitaux de Paris, Lariboisière Hospital, Paris, France
| | - Philippe Herman
- Department of Otolaryngology - Head and Neck Surgery, Assistance Publique-Hopitaux de Paris, Lariboisière Hospital, Paris, France.,Faculty of Medicine, Paris Diderot University, Paris, France
| | - Geoffrey Mortuaire
- Department of Otolaryngology - Head and Neck Surgery, University Hospital and Lille 2 Faculty of Medicine, Lille, France
| | - Xavier Leroy
- Department of Pathology, University Hospital and Lille 2 Faculty of Medicine, Lille, France
| | - Gabriel G Malouf
- Department of Medical Oncology, Hôpitaux Universtiaires de Strasbourg, Institut de Génomique et de Biologie Moléculaire et Cellulaire, Strasbourg, France
| | - Benjamin Verillaud
- Department of Otolaryngology - Head and Neck Surgery, Assistance Publique-Hopitaux de Paris, Lariboisière Hospital, Paris, France.,Faculty of Medicine, Paris Diderot University, Paris, France
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Orton A, Boothe D, Evans D, Lloyd S, Monroe MM, Jensen R, Shrieve DC, Hitchcock YJ. Esthesioneuroblastoma: A Patterns-of-Care and Outcomes Analysis of the National Cancer Database. Neurosurgery 2019; 83:940-947. [PMID: 29481629 DOI: 10.1093/neuros/nyx535] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/28/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The available literature to guide treatment decision making in esthesioneuroblastoma (ENB) is limited. OBJECTIVE To define treatment patterns and outcomes in ENB according to treatment modality using a large national cancer registry. METHODS This study is a retrospective cohort analysis of 931 patients with a diagnosis of ENB who were treated with surgery, radiation therapy, and/or chemotherapy in the United States between the years of 2004 and 2012. Log-rank statistics were used to compare overall survival by primary treatment modality. Logistic regression modeling was used to identify predictors of receipt of postoperative radiotherapy (PORT). Cox proportional hazards modeling was used to determine the survival benefit of PORT. Subgroup analyses identified subgroups that derived the greatest benefit of PORT. RESULTS Primary surgery was the most common treatment modality (90%) and resulted in superior survival compared to radiation (P < .01) or chemotherapy (P < .01). On multivariate analysis, PORT was associated with decreased risk of death (hazard ratio [HR] 0.53, P < .01). PORT showed a survival benefit in Kadish stage C (HR 0.42, P < .01) and D (HR 0.09, P = .01), but not Kadish A (HR 1.17, P = .74) and B (HR 1.37, P = .80). Patients who received chemotherapy derived greater benefit from PORT (HR 0.22, P < .01) compared with those who did not (HR 0.68, P = .13). Predictors of PORT included stage, grade, extent of resection, and chemotherapy use. CONCLUSION Best outcomes were obtained in patients undergoing primary surgery. The benefit of PORT was driven by patients with stages C and D disease, and by those also receiving chemotherapy.
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Affiliation(s)
- Andrew Orton
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah
| | - Dustin Boothe
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah
| | - Daniel Evans
- Department of Radiation Oncology, Univeristy of Utah School of Medicine and Health Sciences, Salt Lake City, Utah
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah
| | - Marcus M Monroe
- Department of Head and Neck Surgery, University of Utah, Salt Lake City, Utah
| | - Randy Jensen
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Dennis C Shrieve
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah
| | - Ying J Hitchcock
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah
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Sipos B. [Neuroendocrine neoplasms of the auditory, olfactory, and visual sensory organs]. DER PATHOLOGE 2019; 39:255-263. [PMID: 29392404 DOI: 10.1007/s00292-017-0411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuroendocrine neoplasms (NENs) are infrequent in sensory organs. There are well-differentiated neuroendocrine neoplasms that should be classified as neuroendocrine tumors, in analogy to their gastrointestinal counterparts, however the nomenclature is inconsistent. The best defined entities are neuroendocrine tumors in the middle ear and ectopic pituitary adenoma in the sphenoid region. Poorly differentiated NENs most often arise in the olfactory organ and nasal cavity that are represented by olfactory neuroblastomas and poorly differentiated neuroendocrine carcinomas. They have several mimickers such as the sinonasal undifferentiated carcinoma, poorly differentiated squamous cell carcinoma, mucosal malignant melanoma, rhabdomyosarcoma, Ewing sarcoma/primitive neuroectodermal tumor and non-Hodgkin lymphoma.
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Affiliation(s)
- B Sipos
- Institut für Allgemeine Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Deutschland.
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Goshtasbi K, Abiri A, Abouzari M, Sahyouni R, Wang BY, Tajudeen BA, Hsu FPK, Cadena G, Kuan EC. Hyams grading as a predictor of metastasis and overall survival in esthesioneuroblastoma: a meta-analysis. Int Forum Allergy Rhinol 2019; 9:1054-1062. [PMID: 31251848 DOI: 10.1002/alr.22373] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, represents up to 3% of all sinonasal neoplasms. Hyams histologic grading is a promising tool in predicting metastases and establishing prognoses for this complex tumor. METHODS A systematic literature search was performed in the PubMed, Ovid MEDLINE, and Cochrane databases. ENB patients with Hyams I-II or III-IV were categorized as low-grade Hyams (LGH) or high-grade Hyams (HGH), respectively. Binary and continuous random-effects models were applied to calculate odds ratios (ORs) for the incidences of neck and distal metastases as well as for 5- and 10-year overall survival rates. RESULTS Of the 57 screened articles published from 1993 to 2018, 16 (525 patients) and 21 (563 patients) provided data for tumor metastases and overall survival rates, respectively. Neck metastasis was observed in 18.2% of HGH vs 7.9% of LGH patients. Distant metastasis was noted in 20.7% of HGH vs 8.9% of LGH patients. LGH patients had 5- and 10-year overall survival rates of 81.2% and 64.0%, respectively, as compared with 60.9% and 40.6%, respectively, for HGH patients. In comparing HGHs vs LGHs, the collective ORs for neck and distant metastases were 2.08 (95% confidence interval [CI], 1.09-3.99; p = 0.03) and 2.37 (95% CI, 1.07-5.26; p = 0.03), respectively. Moreover, in comparing LGHs vs HGHs, collective ORs for 5- and 10-year overall survival rates were 3.39 (95% CI, 2.09-5.49; p < 0.001) and 3.03 (95% CI, 1.82-5.06; p < 0.001), respectively. CONCLUSION HGH ENBs, compared with LGH ENBs, are more likely to metastasize to neck or distal targets and to have lower overall survival rates.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
| | - Ronald Sahyouni
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
| | - Beverly Y Wang
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA
| | - Bobby A Tajudeen
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, CA
| | - Gilbert Cadena
- Department of Neurological Surgery, University of California, Irvine, CA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
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Li R, Tian S, Zhu Y, Yan L, Zhu W, Quan H, Wang S. Management of orbital invasion in esthesioneuroblastoma: 14 years' experience. Radiat Oncol 2019; 14:107. [PMID: 31196122 PMCID: PMC6567903 DOI: 10.1186/s13014-019-1313-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022] Open
Abstract
Background There is a scarcity of data about the prognostic value of orbital invasion in esthesioneuroblastoma (ENB), as well as about its management strategies. Indications for the preservation of orbital contents remain controversial, and the evaluation of orbital invasion has been ill defined. Methods This retrospective analysis contained 60 ENB patients with orbital invasion who underwent radiotherapy with or without surgery over the past 14 years. Orbital invasion was classified into three grades. Results There were 52 patients at stage C and 8 at stage D, according to Foote classifications. Grade I, grade II and grade III orbital invasion was detected in 12, 23, and 25 patients, respectively. The median follow-up was 57 months (IQR 32–95 months). Fourteen patients received radical radiotherapy, with a 5-year overall survival (OS) of 63.5%; 46 received surgery plus radiation, with a 5-year OS of 70.7%; and the difference was not statistically significant (p = 0.847). Orbital preservation was feasible in 100% of cases, including 18 cases that extended to extraocular muscles or the eye globe. Five-year locoregional relapse-free survival was 100% in patients with prophylactic elective neck irradiation (PENI) and 58.1% in patients without PENI (p = 0.004). Univariate analysis showed that grade II/III orbital invasion was associated with poorer OS and progression-free survival. Neck metastasis (with a Foote stage of D) was independently associated with shorter OS and distant metastasis–free survival in multivariate analysis. Conclusions Our data suggested that primary radiotherapy achieved comparable survival to surgery plus radiotherapy in advanced ENB. Invasion of either the extraocular muscles or the eye globe is not a contraindication for eye-sparing surgery. Orbital invasion in grade II/III was significantly associated with adverse survival outcomes. Prophylactic radiotherapy to the neck with N0 significantly reduces the risk of regional recurrence.
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Affiliation(s)
- Ruichen Li
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China
| | - Shu Tian
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China
| | - Yi Zhu
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China
| | - Li Yan
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China
| | - Wenjia Zhu
- Department of E.N.T, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Huatao Quan
- Department of E.N.T, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Shengzi Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui, Shanghai, 200031, People's Republic of China.
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Biau J, Lapeyre M, Troussier I, Budach W, Giralt J, Grau C, Kazmierska J, Langendijk JA, Ozsahin M, O'Sullivan B, Bourhis J, Grégoire V. Selection of lymph node target volumes for definitive head and neck radiation therapy: a 2019 Update. Radiother Oncol 2019; 134:1-9. [DOI: 10.1016/j.radonc.2019.01.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/15/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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