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Hirunpat P, Panyaping T, Hirunpat S. Olfactory Neuroblastoma Is Not Always Located at the Roof of the Nasal Cavity. J Belg Soc Radiol 2024; 108:39. [PMID: 38826683 PMCID: PMC11141505 DOI: 10.5334/jbsr.3562] [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: 03/01/2024] [Accepted: 03/22/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives To evaluate the imaging characteristics of the tumor, emphasizing its location, and to determine the frequency of typical and atypical locations of olfactory neuroblastoma (ONB). Materials and Methods We retrospectively reviewed the computed tomography and magnetic resonance imaging findings of patients with pathologically proven ONB between April 2000 and April 2023. Demographic information, chief complaints, tumor location, and tumor extension were extracted. Results Of the 58 patients, 50 (86.2%) had the epicenter of the mass at the superior part of the nasal cavity, while eight patients (13.8%) had the epicenter at other atypical locations: seven patients (12.1%) at the middle part of the nasal cavity and one patient (1.7%) within both sphenoid sinuses. Conclusion ONB is not always present in the upper part or the roof of the nasal cavity, and a significant number of ONBs are occasionally found in the rest of the nasal cavity and other atypical locations.
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Affiliation(s)
- Pornrujee Hirunpat
- Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Theeraphol Panyaping
- Division of Neurological Radiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siriporn Hirunpat
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
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2
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Sghier AB, Samba S, Bouabid M, Berhili S, Moukhlissi M, Mezouar L. A rare presentation of esthesioneuroblastoma: a case report and review of the literature. Pan Afr Med J 2023; 46:111. [PMID: 38465014 PMCID: PMC10924622 DOI: 10.11604/pamj.2023.46.111.42205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 03/12/2024] Open
Abstract
Esthesioneuroblastoma is a rare malignant tumor developing from the olfactory neuroepithelium. It represents less than 5% of all cancers of the nasal cavity. We are going to report the observation of a patient followed at the regional oncology center of Oujda in Morocco who presented a locally advanced esthesioneuroblastoma. Treatment consisted of surgical resection followed by adjuvant radiotherapy on the tumor bed. Currently, the patient is in good control of his disease.
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Affiliation(s)
- Ahmed Ben Sghier
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Soumiya Samba
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Meriem Bouabid
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Soufiane Berhili
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Mohammed Moukhlissi
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Loubna Mezouar
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
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3
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Geltzeiler M, Choby GW, Ji KSY, JessMace C, Almeida JP, de Almeida J, Champagne PO, Chan E, Ciporen JN, Chaskes MB, Cornell S, Drozdowski V, Fernandez-Miranda J, Gardner PA, Hwang PH, Kalyvas A, Kong KA, McMillan RA, Nayak JV, Patel C, Patel ZM, Celda MP, Pinheiro-Neto C, Sanusi OR, Snyderman CH, Thorp BD, Van Gompel JJ, Zadeh G, Zenonos G, Zwagerman NT, Wang EW. Radiographic predictors of occult intracranial involvement in olfactory neuroblastoma patients. Int Forum Allergy Rhinol 2023; 13:1876-1888. [PMID: 36841933 DOI: 10.1002/alr.23145] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Traditional management of olfactory neuroblastoma (ONB) includes margin-negative resection with removal of cribriform plate, dura, and olfactory bulb, regardless of intracranial disease. This approach may be overtreating certain patients. Our investigation examines risk factors associated with occult intracranial disease to optimize therapeutic outcomes. METHODS This retrospective, multi-institutional cohort study examined clinical covariates associated with occult intracranial involvement. Patient demographics, staging, Hyam's grade, and pathologic involvement of dura, olfactory bulb/tract, and brain were collected. Diagnostic imaging was reviewed. Positive and negative predictive value (NPV) were estimated along with effect size estimates. Cox hazard regression examined associations with overall survival (OS) and disease-free survival (DFS). RESULTS A total of 224 subjects with new diagnoses of ONB (2005-2021) were identified. Skull base bone involvement on computed tomography (CT) had the highest NPV for pathologic dura (88.0%), olfactory bulb (88%), and brain involvement (97.3%). Hyam's grade category was significantly associated with dural involvement (φC = 0.26; 95% confidence interval [CI]: 0.16, 0.42). Subjects without radiologic skull base involvement (n = 66) had pathologic positivity of 12.1%. Within this subgroup, Hyam's grade was clinically significant for dural positivity (φ = 0.34; 95% CI: -0.12, 0.71) with 28.6% involvement in high grade tumors. Neither clinical nor pathologic positivity of intracranial structures were associated with significantly different OS or DFS. CONCLUSIONS Both CT and magnetic resonance imaging (MRI) had reasonably good NPV for involvement of dura and olfactory bulb. Higher Hyam's grade was associated with dural involvement. Patients with low-grade tumors not involving the skull base may be suitable for avoiding skull base resection; however, further investigation is warranted.
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Affiliation(s)
- Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Garret W Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Keven Seung Yong Ji
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - C JessMace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Joao Paulo Almeida
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - John de Almeida
- Department of Surgery, University of Toronto, Ontario, Canada
| | | | - Erik Chan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Jeremy N Ciporen
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark B Chaskes
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarah Cornell
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Veronica Drozdowski
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | | | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | | | - Keonho A Kong
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ryan A McMillan
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Chirag Patel
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Maria Peris Celda
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos Pinheiro-Neto
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Olabisi R Sanusi
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jamie J Van Gompel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gelareh Zadeh
- Department of Surgery, University of Toronto, Ontario, Canada
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nathan T Zwagerman
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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4
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Amjad QM, Danishwar M, Pervaiz S, Kumar S, Varrassi G. Achieving Cure Without Surgery for Olfactory Neuroblastoma: A Case Report and Literature Review. Cureus 2023; 15:e39614. [PMID: 37384073 PMCID: PMC10299856 DOI: 10.7759/cureus.39614] [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: 05/21/2023] [Accepted: 05/28/2023] [Indexed: 06/30/2023] Open
Abstract
Olfactory neuroblastoma is a rare, undifferentiated carcinoma of the nasal cavity. It is an extremely rare malignancy, usually occurring in the sixth decade of life with no known underlying cause. In this case report, we present a 71-year-old male with an enlarging facial mass near the right medial nasal bridge, initially diagnosed as undifferentiated carcinoma on biopsy and later confirmed as olfactory neuroblastoma eroding into the anterior skull base. Our patient presented with the signs and symptoms of epiphora, epistaxis, intermittent headaches, anosmia, and an enlarging facial mass. The treatment modalities include surgery, radiation therapy, and chemotherapy. The purpose of this case report is to highlight the importance of chemotherapy and adjuvant radiotherapy for treatment without the need for surgery. Further studies need to be done to divulge the risk factors for olfactory neuroblastoma and to implore new chemotherapeutic treatment modalities that minimize long-term mortality and morbidity.
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Affiliation(s)
| | - Mahmood Danishwar
- Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
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5
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Carlstrom LP, Van Gompel JJ, Choby G. Olfactory Neuroblastoma: Treatment Strategies for Advanced Disease. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023. [DOI: 10.1007/s40136-023-00447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Shaaban SG, Caicedo-Granados E, Wilke C. Clinical Outcomes and Patterns of Failure in Esthesioneuroblatoma: A Single Institutional Experience. Indian J Otolaryngol Head Neck Surg 2023; 75:67-73. [PMID: 37007884 PMCID: PMC10050542 DOI: 10.1007/s12070-022-03125-x] [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: 12/26/2021] [Accepted: 07/10/2022] [Indexed: 11/28/2022] Open
Abstract
Esthesioneuroblastoma (ENB) is a rare sinonasal malignancy that is typically managed with a combination of surgical resection, radiotherapy and chemotherapy. Data used to guide therapeutic decision making are scant and typically obtained from small retrospective series due to the relative infrequency of the diagnosis. Here, we report our own institutional experience in the management of patients with ENB to help compliment these prior single institutional reports. Records from patients receiving treatment for ENB at the University of Minnesota Medical Center were obtained from 1994 to 2019. A total of 17 patients were identified from our retrospective review. Kadish stage at initial presentation was A in 2 (12%), B in 5 (29%), C in 9 (53%) and D in 1 (6%). All patients underwent surgical resection. Adjuvant radiotherapy was utilized in 12 (71%) patients with concurrent chemotherapy administered in 3 (18%) patients. One patient received neoadjuvant chemoradiotherapy followed by surgical resection. Four patients developed recurrent disease with locoregional failure presenting as the most common site of initial relapse within our study population. Isolated local recurrence occurred in 2 patients, one patient developed combined local and regional failure, while another had combined regional and distant failure with osseous metastases. Recurrent disease was managed by either combined salvage surgery and radiotherapy (RT) or RT alone. Three of the 4 patients who developed recurrence eventually succumbed to their disease. Estimates for 5-year DFS and OS were 65% and 90%, respectively, for the entire cohort.
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Affiliation(s)
- Sherif G. Shaaban
- Department of Radiation Oncology, University of Minnesota Medical Center, Phillips-Wangensteen Building, 516 Delaware Street SE, PWB-1, Minneapolis, MN 55455 USA
| | - Emiro Caicedo-Granados
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Minneapolis, MN USA
| | - Christopher Wilke
- Department of Radiation Oncology, University of Minnesota Medical Center, Phillips-Wangensteen Building, 516 Delaware Street SE, PWB-1, Minneapolis, MN 55455 USA
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7
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Liang W, Wang Y, Sun W, Li D, Zhang X, Zhu P, Zhu Z, Fang Y. Persistent pain and numbness in the extremities of an adult due to paraneoplastic peripheral neuropathy caused by olfactory neuroblastoma: A case report. Front Neurol 2023; 13:1002076. [PMID: 36698887 PMCID: PMC9868692 DOI: 10.3389/fneur.2022.1002076] [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: 08/24/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Background Paraneoplastic peripheral neuropathy (PPN) caused by olfactory neuroblastoma (ONB) has not yet been reported. Case report We present a rare case of an adult who hospitalized repeatedly over the past 9 months for persistent pain and numbness in the limbs. This patient was initially diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) and treated accordingly, but neurological symptoms did not improve significantly. After this admission, FDG-PET/CT showed focal hypermetabolism of a soft-tissue mass in the nasal cavity, and further lesion biopsy suggested ONB. Combined with positive serum anti-Hu antibody, the diagnosis of PPN associated with ONB was eventually made. Furthermore, the patient's neurological symptoms were relieved after removal of the primary tumor, confirming the accuracy of the diagnosis. Conclusion Our case not only expanded the clinical characteristics of ONB but also highlighted the importance of early and comprehensive tumor screening for the diagnosis of PPN.
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Affiliation(s)
- Wenwen Liang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanyan Wang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenzhe Sun
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dongrui Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoping Zhang
- Department of Infection, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Pengcheng Zhu
- Department of Pathology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhou Zhu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Zhou Zhu ✉
| | - Yongkang Fang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China,Yongkang Fang ✉
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8
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Birkenbeuel JL, Pang JC, Lee A, Nguyen ES, Risbud A, Goshtasbi K, Abiri A, Lehrich BM, Tong CCL, Adappa ND, Palmer JN, Kuan EC. Long-term outcomes in sinonasal squamous cell carcinoma arising from inverted papilloma: Systematic review. Head Neck 2022; 44:1014-1029. [PMID: 35141984 DOI: 10.1002/hed.26995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/03/2021] [Accepted: 01/24/2022] [Indexed: 12/30/2022] Open
Abstract
Long-term survival and recurrence patterns of squamous cell carcinoma arising from inverted papilloma (IP-SCC) have not been thoroughly investigated. Four electronic databases were searched and primary studies describing overall survival (OS), recurrence, and mean time to recurrence of patients with IP-SCC were included for review. Our search yielded 662 studies. The 28 studies selected for inclusion identified 663 patients with IP-SCC. In 596 patients with reported T classification, 439 (73.7%) were T3/T4 on presentation. Of the 650 participants with recurrence data (local, regional, and distant), 155 (23.8%) experienced a recurrence, with an aggregate mean time-to-recurrence of 24.3 months. In 565 patients with 5-year OS rates, the aggregate 5-year OS was 62%. Based on the literature to date, IP-SCC is associated with a 5-year OS rate of 62%. 23.8% of patients experienced recurrence at a mean time of 24.3 months, suggesting the need for long-term surveillance.
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Affiliation(s)
- Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Ariel Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Emily S Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Adwight Risbud
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
| | - Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Charles C L Tong
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James N Palmer
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
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9
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Al-Osaimi SM, Hameed AA, Alsufyani AA, Altwairqi RG, Alotaibi AF. Olfactory Neuroblastoma Managed with Endoscopic Sinus Surgery. J Pharm Bioallied Sci 2021; 13:S1728-S1732. [PMID: 35018064 PMCID: PMC8686966 DOI: 10.4103/jpbs.jpbs_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/25/2021] [Accepted: 04/09/2021] [Indexed: 11/15/2022] Open
Abstract
Olfactory neuroblastoma (ONB) or esthesioneuroblastoma is a rare malignancy of the nose and paranasal sinuses that originates from the upper nasal vault. We report a rare case of ONB in a 27-year-old female patient with a 2-year history of nasal obstruction, sneezing, nasal discharge, and left eye protrusion. The patient was successfully treated with endoscopic sinus surgery and adjuvant radiotherapy (RT) with 5-year follow-up duration. Studying ONB cases is of great importance due to its rare occurrence, and the lack of literature regarding its management often creates a dilemma leading to nonstandardized treatment methods. Prolonged surveillance is essential due to its late recurrence and endoscopic resection followed by adjuvant RT, which may be a feasible and effective treatment. There is no single case of ONB published yet in Saudi Arabia, and to our knowledge, this is the first case report.
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Affiliation(s)
- Saleh Mayoof Al-Osaimi
- Department of Otorhinolaryngology-Head and Neck Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Althumali Abdulaziz Hameed
- General Practitioner, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia,Address for correspondence: Dr. Althumali Abdulaziz Hameed, King Abdulaziz Specilaist Hospital, Taif, Saudi Arabia. E-mail:
| | | | - Rahaf Ghazi Altwairqi
- Department of Otorhinolaryngology-Head and Neck Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Abrar Fahad Alotaibi
- Department of Otorhinolaryngology-Head and Neck Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
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10
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Brisson RJ, Quinn TJ, Deraniyagala RL. The role of chemotherapy in the management of olfactory neuroblastoma: A 40-year surveillance, epidemiology, and end results registry study. Health Sci Rep 2021; 4:e257. [PMID: 33969231 PMCID: PMC8088587 DOI: 10.1002/hsr2.257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/16/2021] [Accepted: 02/08/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In this retrospective surveillance, epidemiology, and end results (SEER) registry analysis, we investigated the role of chemotherapy (CT) in the treatment of olfactory neuroblastoma (ON), an exceedingly rare sino-nasal tumor typically treated with surgery and/or radiation therapy (RT). METHODS We analyzed all patients in the SEER registry diagnosed with a single primary malignancy of ON, a primary tumor site within the nasal cavity or surrounding sinuses, sufficient staging information to derive Kadish staging, and >0 days of survival, ensuring follow-up data. Receipt of CT in the SEER registry was documented as either Yes or No/Unknown. RESULTS Six hundred and thirty-six patients were identified. One hundred and ninety-five patients received CT as part of their treatment for ON. Following propensity score matching and inverse probability of treatment weighting, there was inferior overall survival (OS) (HR 1.7, 95% CI: 1.3-2.2, P = .001) and cancer-specific survival (CSS) (HR 1.8, 95% CI: 1.3-2.4, P < .001) for patients who received CT compared to those who were not treated with CT or had unknown CT status. On subgroup analysis, the only patient population that derived benefit from CT were patients who did not receive surgery and were treated with CT and/or RT (HR 0.3, 95% CI: 0.14-0.61, P < .001). CONCLUSIONS Based on this retrospective SEER registry analysis, the use of CT in the management of ON is associated with decreased OS. Our analysis suggests that patients who are considered nonsurgical candidates may benefit from the addition of CT.
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Affiliation(s)
- Ryan J. Brisson
- Department of Internal MedicineHenry Ford HospitalDetroitMichigan
| | - Thomas J. Quinn
- Department of Radiation OncologyBeaumont HealthRoyal OakMichigan
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11
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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: 8] [Impact Index Per Article: 2.7] [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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12
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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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13
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König M, Osnes T, Bruland Ø, Sundby Hall K, Bratland Å, Meling TR. The Role of Adjuvant Treatment in Craniofacial Malignancy: A Critical Review. Front Oncol 2020; 10:1402. [PMID: 32850452 PMCID: PMC7426725 DOI: 10.3389/fonc.2020.01402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Tumors originating from the craniofacial region usually present in a locally advanced stage with frequent involvement of adjacent sites and have a strong tendency for local recurrence in the absence of adjuvant therapy, even when the original surgical resection was presumed to be radical. In the past decades, several advances in the radiological diagnosis and treatment of craniofacial malignancies have been introduced. There are, however, no randomized trials that define the optimal multimodal treatment of these tumors because of their rarity as well as heterogeneity in both histology and site of origin. The aim of this study was to conduct a critical review of the role of adjuvant therapy in the treatment of craniofacial malignancy. Method: We conducted a critical review of the past and contemporary literature available, focusing on adjuvant oncological treatments of the most common craniofacial malignancies. Results: Preoperative radiotherapy can have a documented role in the treatment of olfactory neuroblastoma and soft tissue sarcoma, while preoperative chemotherapy can be advocated in the treatment of sinonasal undifferentiated carcinoma, neuroendocrine carcinoma, olfactory neuroblastoma, and craniofacial sarcoma (both soft-tissue and high-grade osteosarcoma). Postoperative radiotherapy has a well-established role in the treatment of most craniofacial malignancies. The role of postoperative chemotherapy is unclear in most histologies, but is commonly used during the treatment of well-selected cases of paranasal sinus carcinoma, olfactory neuroblastoma, mucosal melanoma, soft tissue sarcoma and high-grade craniofacial osteosarcoma. Discussion: Alongside developments in surgery, there have also been improvements in diagnostics, radiotherapy, and chemotherapy. Implementation of novel radiation techniques allows delivery of higher radiation doses while minimizing irradiation-related morbidity. Better understanding of tumor biology allows the construction of more complex treatment strategies, incorporating adjuvant chemotherapy either pre- or postoperatively. In the era of personalized targeted therapy, rapid strides are being made to identify specific tumor-targets for use of novel biologic agents, with the potential to change current management paradigms.
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Affiliation(s)
- Marton König
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Terje Osnes
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Øyvind Bruland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Åse Bratland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Torstein R. Meling
- Service de Neurochirurgie, Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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14
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VanKoevering KK, Sabetsarvestani K, Sullivan SE, Barkan A, Mierzwa M, McKean EL. Pituitary Dysfunction after Radiation for Anterior Skull Base Malignancies: Incidence and Screening. J Neurol Surg B Skull Base 2020; 81:75-81. [PMID: 32021753 DOI: 10.1055/s-0039-1679893] [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: 08/20/2018] [Accepted: 12/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background Management of anterior cranial base malignancies requires multidisciplinary care. Radiation therapy remains a mainstay of definitive or adjuvant treatment. Apart from primary hypothyroidism, the effects of radiation on the hypothalamic-pituitary axis after high-dose treatment of head and neck malignancies remain poorly described. We describe a comprehensive screening protocol for surveillance and characterize the incidence of pituitary dysfunction after radiation for anterior cranial base malignancies. Methods A review of patients prospectively enrolled in a skull base registry at an academic center was performed. Included patients had a history of anterior skull base malignancy and external beam radiation to the primary site, with comprehensive post-treatment pituitary serologies and at least 1 year of post-radiation follow-up. Routine hormonal screening was initiated during the study period for all patients with anterior skull base irradiation. Results Eighty-one patients met inclusion. Fifty-eight patients (71%) demonstrated some laboratory abnormality. Thirty patients (37%) demonstrated evidence of hypopituitarism. Twenty-four (29%) demonstrated central hypogonadism, and 16% of patients showed central hypothyroidism. Ten patients (12%) displayed central adrenal insufficiency with six patients demonstrating panhypopituitarism. Primary tumor location and maximum dose of radiation to the gland appeared to correlate with incidence of hypopituitarism. Conclusion Radiation for malignancies of the anterior skull base resulted in a 37% incidence of hypopituitarism in our study. Given the potential morbidity of hypopituitarism, we recommend annual post-treatment screening in these patients. We describe a comprehensive set of serologies that can be utilized, and recommend updating clinical guidelines to reflect the necessity of this screening.
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Affiliation(s)
- Kyle K VanKoevering
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Stephen E Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Ariel Barkan
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States
| | - Erin L McKean
- Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States.,Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
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15
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Guerreiro IM, Vieira C, Soares A, Braga A, Jácome M, Dinis J. Management of Locally Advanced Esthesioneuroblastoma in a Pregnant Woman. Case Rep Oncol Med 2019; 2019:3789317. [PMID: 31531255 PMCID: PMC6721265 DOI: 10.1155/2019/3789317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 11/18/2022] Open
Abstract
Esthesioneuroblastoma (ENB) is a rare malignant tumor that commonly develops in the upper nasal cavity. Standard treatment is not established, especially in locally advanced disease which portends the worse prognosis. Hereby, we report a case of a 27-year-old, 23-week pregnant woman, with a 2-month history of progressively growing right cervical lymphadenopathy, nasal obstruction, anosmia, frequent episodes of epistaxis, and right frontal headache. Imagiological evaluation revealed a lesion with 7×5,2×3,2 cm in the nasal fossae with extension to the ethmoidal complex and right olfactive fend and invasion of the endocranial compartment associated with lymphadenopathy. The biopsy revealed a high-grade EBN. Neoadjuvant chemotherapy with cisplatin and etoposide was administrated during pregnancy and continued after delivery up to 6 cycles of treatment with partial response. Radiotherapy followed, with complete response. This case report is intended to highlight that a high grade of suspicion should be kept in the presence of nonspecific symptoms of nasal obstruction, anosmia, facial pain, and/or headache and focus that chemotherapy is an important component of a combined-treatment modality for locally advanced ENB that can be used during pregnancy in a lifesaving situation.
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Affiliation(s)
- Inês Maria Guerreiro
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal
| | - Cláudia Vieira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal
| | - André Soares
- Radiation Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal
| | - António Braga
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
| | - Manuel Jácome
- Pathology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal
| | - José Dinis
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-PORTO), Porto, Portugal
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16
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Fiani B, Quadri SA, Cathel A, Farooqui M, Ramachandran A, Siddiqi I, Ghanchi H, Zafar A, Berman BW, Siddiqi J. Esthesioneuroblastoma: A Comprehensive Review of Diagnosis, Management, and Current Treatment Options. World Neurosurg 2019; 126:194-211. [PMID: 30862589 DOI: 10.1016/j.wneu.2019.03.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Many controversies exist in the diagnosis and management of this aggressively malignant condition, mainly because of limited literature and lack of randomized control trials, resulting in nonstandardized treatment methods. We performed a comprehensive review of the literature to identify management approach and treatment options for esthesioneuroblastoma. METHODS An extensive review of the published literature was conducted in PubMed, OVID Medline, and EMBASE journals for studies of esthesioneuroblastoma. Terms for search included esthesioneuroblastoma (ENB) and olfactory neuroblastoma (ONB). No date restrictions were used. RESULTS The search yielded 3876 related articles. Cross-checking of articles led to exclusion of duplicate articles. The remaining 1170 articles were screened for their full text and English language availability. Of 609 full-text articles available, animal studies, irrelevant articles, and studies with mixed/confusing data were excluded. We finalized 149 articles pertaining to the topic, including 119 original research articles, 3 book chapters, 11 reviews, 9 case reports, and 7 case series. CONCLUSIONS Surgical resection followed by radiotherapy is the standard for treatment for higher-grade lesions. The endoscopic endonasal approach is gaining further recognition with more favorable outcomes and better survival than for open surgery. Postoperative radiotherapy is associated with the highest overall survival and shows benefit for patients with higher-stage disease and those who receive chemotherapy. Recurrence rates after treatment vary drastically in the literature and, therefore, prolonged follow-up with repeated imaging is recommended. Lifelong surveillance is recommended because of late recurrences associated with this tumor.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California.
| | - Syed A Quadri
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alessandra Cathel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California
| | - Mudassir Farooqui
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Anirudh Ramachandran
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
| | - Imran Siddiqi
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA
| | - Atif Zafar
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Blake W Berman
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California
| | - Javed Siddiqi
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California
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17
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Joshi RR, Husain Q, Roman BR, Cracchiolo J, Yu Y, Tsai J, Kang J, McBride S, Lee NY, Morris L, Ganly I, Tabar V, Cohen MA. Comparing Kadish, TNM, and the modified Dulguerov staging systems for esthesioneuroblastoma. J Surg Oncol 2018; 119:130-142. [PMID: 30466166 DOI: 10.1002/jso.25293] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB) is a rare neuroendocrine tumor. The purpose of this study was to compare the Kadish, tumor-node-metastasis (TNM), and Dulguerov's modified TNM staging in order to determine the impact of the stage on primary surgical treatment selection, margin status, and survival. METHODS The National Cancer Database (NCDB) was used to identify patients diagnosed with ENB between 2004 to 2015. Patients were excluded based on the ability to properly stage their disease as well as the availability of treatment data. RESULTS Eight-hundred eighty-three patients had sufficient data for analysis. On multivariate analysis, age and government insurance were associated with primary surgical treatment, whereas tumor stage, gender, race, hospital type and volume, and comorbidity score were not. Age, charlson-deyo comorbidity (CDCC) score, hospital volume, and nodal status were found to be predictors of survival. Multivariate-analysis controlling for stage failed to demonstrate clear survival differences between staging in both TNM and Kadish systems. T-stage and the presence of regional nodal metastasis were associated with an increased risk of positive margins on multivariate analysis. CONCLUSION Although primary surgical management and positive margins can be predicted by certain patient and tumor factors, clinical staging systems for ENB poorly predict prognosis over a 10-year horizon.
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Affiliation(s)
- Rohan R Joshi
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Medical Center, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York
| | - Qasim Husain
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Medical Center, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York
| | | | - Jennifer Cracchiolo
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julie Kang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc Morris
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Cohen
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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18
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Intensity-modulated radiotherapy for paranasal sinuses and base of skull tumors. Oral Oncol 2018; 86:61-68. [PMID: 30409321 DOI: 10.1016/j.oraloncology.2018.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/11/2018] [Indexed: 02/03/2023]
Abstract
Paranasal sinus and skull base tumors are rare aggressive head and neck cancers, and typically present in the locally advanced stages. As a result, achieving wide surgical resection with clear margins is a challenge for these tumors, and radiotherapy is thus usually indicated as an adjuvant modality following surgery to optimize local control. Given the integral role of radiotherapy in the management of this subgroup of head and neck tumors, the advent of intensity-modulated radiotherapy (IMRT) has led to substantial improvement of clinical outcomes for these patients. This is primarily driven by the improvement in radiation dosimetry with IMRT compared to conventional two dimensional (2D)- and 3D-techniques, in terms of ensuring dose intensity to the tumor target coupled with minimizing dose exposure to critical organs. Consequently, the evident clinical benefits of IMRT have been in reduction of normal tissue toxicities, ranging from critical neurological symptoms to less debilitating but bothersome symptoms of eye infections and radiation-induced skin changes. Another domain where IMRT has potential clinical utility is in the management of a subset of non-resectable T4 paranasal sinus and skull base tumors. For these inoperable lesions, the steep dose-gradient between tumor and normal tissue is even more advantageous, given the crucial need to maintain dose intensity to the tumor. Innovative strategies in this space also include the use of induction chemotherapy for patient selection. In this review, we summarized the data for the aforementioned topics, including specific discussions on the different histologic subtypes of paranasal sinus and skull base tumors.
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19
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Bartel R, Gonzalez-Compta X, Cisa E, Cruellas F, Torres A, Rovira A, Manos M. Importance of neoadjuvant chemotherapy in olfactory neuroblastoma treatment: Series report and literature review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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20
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Saito A, Sasaki T, Inoue T, Narisawa A, Inoue T, Suzuki S, Ezura M, Uenohara H. Non-contiguous Meningeal Recurrence of Olfactory Neuroblastoma: A Case Report and Literature Review. NMC Case Rep J 2018; 5:69-72. [PMID: 30023143 PMCID: PMC6048349 DOI: 10.2176/nmccrj.cr.2017-0233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/10/2018] [Indexed: 01/26/2023] Open
Abstract
Olfactory neuroblastoma is an uncommon malignant tumor of neural crest origin arising from the olfactory epithelium of the superior nasal cavity. There are some reports of local recurrence or continuous extension along the olfactory epithelium to the central nervous system, but non-contiguous distant meningeal metastasis without local recurrence at the primary site is rare. We report a case of non-contiguous meningeal recurrence of olfactory neuroblastoma presenting as a giant frontal mass. A 66-year-old woman was admitted with a left nasal intranasal localized tumor without cranial extension and gross total removal was achieved. Pathological examination showed olfactory neuroblastoma and radiation therapy was added in a limited region of the removal cavity. Radiological follow-up continued for 10 years and there was no local recurrence. Sixteen years after radiation therapy, the patient found a slight frontal mass gradually growing. Magnetic resonance imaging revealed an enhanced mass lesion of 7 cm in thickness and 9 cm in diameter associated with marked thickness of the frontal bone, intradural cystic mass compressing the bilateral frontal lobe, and no local recurrence. A second operation was performed followed by radiotherapy and we diagnosed no-contiguous meningeal recurrence of metastatic olfactory neuroblastoma. Olfactory neuroblastoma is a locally aggressive tumor. Although metastasis of this tumor has been reported, non-contiguous spread to the dura is rare. Understanding the route of remote metastasis and careful evaluation after primary treatment are needed to avoid misdiagnosis and treatment delays.
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Affiliation(s)
- Atsushi Saito
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Takashi Sasaki
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Tomoo Inoue
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Ayumi Narisawa
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Takashi Inoue
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Shinsuke Suzuki
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Masayuki Ezura
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
| | - Hiroshi Uenohara
- Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan
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21
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Yu K, Roncaroli F, Kearney T, Ewins D, Beeharry D, Naylor T, Ray D, Bhalla R, Gnanalingham K. Ectopic Cushing's syndrome secondary to olfactory neuroblastoma. Acta Neurochir (Wien) 2018; 160:1023-1026. [PMID: 29340776 PMCID: PMC5897482 DOI: 10.1007/s00701-017-3447-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/21/2017] [Indexed: 02/05/2023]
Abstract
We present the case of a patient with Cushing's syndrome secondary to ectopic ACTH secretion. A MR of the head showed a left-sided nasal mass extending down from the cribriform plate. The patient underwent endoscopic resection with nearly complete removal of the mass. Histological examination showed an ACTH-secreting olfactory neuroblastoma (ONB). The patient's cortisol levels returned to normal range after surgery and have remained normal for over a year. ONB is a rare cause for ectopic ACTH secretion. This case highlights the diagnostic and management difficulties in patients with ectopic ACTH secretion, and provides a brief review of ONB.
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Affiliation(s)
- Kenny Yu
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, M6 8HD, UK.
| | - Federico Roncaroli
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Biological Science, University of Manchester, Manchester, M13 9PT, UK
| | - Tara Kearney
- Department of Endocrinology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, M6 8HD, UK
| | - David Ewins
- Department of Endocrinology, Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
| | - Deepa Beeharry
- Department of Endocrinology, Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
| | - Thomas Naylor
- Department of Endocrinology, Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK
| | - David Ray
- Department of Endocrinology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, M6 8HD, UK
| | - Rajiv Bhalla
- Department of Otorhinolaryngology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, M6 8HD, UK
| | - Kanna Gnanalingham
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, M6 8HD, UK
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Abstract
PURPOSE OF REVIEW To provide a comprehensive review of the literature focusing on the recent advances in the diagnosis and management of olfactory neuroblastoma. RECENT FINDINGS Multimodality treatment is usually recommended for the majority of ONB cases. Recent advances in surgical approaches include the evolving role of endonasal endoscopic surgical resection and reconstruction. The introduction of new conformal radiation techniques has improved the outcomes and reduced treatment-related toxicity to important structures such as the eye and the brain. The role of neoadjuvant and adjuvant chemotherapy is yet to be defined. In the last two decades, there have been advances in surgical techniques with endoscopic approaches, either alone or in combination with craniotomy, gradually replacing the open traditional approaches. Prolonged surveillance is recommended for ONB due to late recurrences associated with that tumor. The role of chemotherapy and elective neck irradiation is still controversial and needs more studies to investigate their optimal role.
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23
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Czapiewski P, Kunc M, Haybaeck J. Genetic and molecular alterations in olfactory neuroblastoma: implications for pathogenesis, prognosis and treatment. Oncotarget 2018; 7:52584-52596. [PMID: 27256979 PMCID: PMC5239575 DOI: 10.18632/oncotarget.9683] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/19/2016] [Indexed: 12/11/2022] Open
Abstract
Olfactory neuroblastoma (ONB, Esthesioneuroblastoma) is an infrequent neoplasm of the head and neck area derived from olfactory neuroepithelium. Despite relatively good prognosis a subset of patients shows recurrence, progression and/or metastatic disease, which requires additional treatment. However, neither prognostic nor predictive factors are well specified. Thus, we performed a literature search for the currently available data on disturbances in molecular pathways, cytogenetic changes and results gained by next generation sequencing (NGS) approaches in ONB in order to gain an overview of genetic alterations which might be useful for treating patients with ONB. We present briefly ONB molecular pathogenesis and propose potential therapeutic targets and prognostic factors. Possible therapeutic targets in ONB include: receptor tyrosine kinases (c-kit, PDGFR-b, TrkB; EGFR); somatostatin receptor; FGF-FGFR1 signaling; Sonic hedgehog pathway; apoptosis-related pathways (Bcl-2, TRAIL) and neoangiogenesis (VEGF; KDR). Furthermore, we compare high- and low-grade ONB, and describe its frequent mimicker: sinonasal neuroendocrine carcinoma. ONB is often a therapeutic challenge, so our goal should be the implementation of acquired knowledge into clinical practice, especially at pretreated, recurrent and metastatic stages. Moreover, the multicenter molecular studies are needed to increase the amount of available data.
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Affiliation(s)
- Piotr Czapiewski
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Kunc
- Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Johannes Haybaeck
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Graz, Austria
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24
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Importance of neoadjuvant chemotherapy in olfactory neuroblastoma treatment: Series report and literature review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:208-213. [PMID: 29061289 DOI: 10.1016/j.otorri.2017.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Olfactory neuroblastoma (ONB) is a rare entity that constitutes less than 5% of nasosinusal malignancies. Mainstream treatment consists in surgical resection+/-adjuvant radiotherapy. By exposing results observed with apparition of new therapeutic options as neoadjuvant chemotherapy, the objective is to evaluate a series and a review of the current literature. METHODS A retrospective review was conducted including patients diagnosed and followed-up for ONB from 2008 to 2015 in our institution. RESULTS 9 patients were included. Mean follow-up of 52.5 months (range 10-107). Kadish stage: A, 1 patient (11.1%) treated with endoscopic surgery; B, 2 patients (22.2%) treated with endoscopic surgery (one of them received adjuvant radiotherapy); C, 6 patients (66.7%), 4 patients presented intracranial extension and were treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. The other 2 patients presented isolated orbital extension, treated with radical surgery (endoscopic or craniofacial resection) plus radiotherapy. The 5-year disease free and overall survival observed was 88.9%. CONCLUSION Neoadjuvant chemotherapy could be an effective treatment for tumor reduction, improving surgical resection and reducing its complications.
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25
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Wertz A, Hollon T, Marentette LJ, Sullivan SE, McHugh JB, McKean EL. Surgical Treatment of Olfactory Neuroblastoma: Major Complication Rates, Progression Free and Overall Survival. J Neurol Surg B Skull Base 2017; 79:151-155. [PMID: 29868319 DOI: 10.1055/s-0037-1605593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 06/21/2017] [Indexed: 10/19/2022] Open
Abstract
Objective We aimed to compare major complication rates in patients undergoing open versus endoscopic resection of olfactory neuroblastoma (ONB) and to determine the prognostic utility of the Kadish staging and Hyams grading systems with respect to progression-free survival (PFS) and overall survival (OS). Methods It is a retrospective review of experience in treating ONB at a single tertiary care hospital from 1987 through 2015. Major complications were defined as cerebrospinal fluid (CSF) leak, meningitis, osteomyelitis, tracheostomy, and severe neurologic injury. Results Forty-one patients were included. An open approach was used in 34 (83%), endoscopic in 6 (15%), and combined in 1 (2%) case. Rates of major complications by surgical approach were 17% after endoscopic versus 31% after open ( p = 0.65). There was no significant difference in PFS or OS based on Kadish B versus C (PFS, p = 0.28; OS, p = 0.11) or Hyams grade 1 and 2 versus Hyams grade 3 and 4 (PFS, p = 0.53; OS, p = 0.38). Conclusions There was no significant difference in major complications between open and endoscopic approaches for the treatment of ONB. Patient stratification using the Kadish staging and Hyams grading systems did not show significant differences in PFS or OS. Further research is needed to determine if a different staging system would better predict patient outcomes.
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Affiliation(s)
- Aileen Wertz
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Todd Hollon
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Lawrence J Marentette
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States.,Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Stephen E Sullivan
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Erin L McKean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States
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Shahriari M, Shakibazad N, Moradi M. Esthesioneuroblastoma Presenting with Bilateral Proptosis and Blindness in a Child: A Case Report. J Clin Diagn Res 2017; 11:XD01-XD02. [PMID: 28969258 PMCID: PMC5620899 DOI: 10.7860/jcdr/2017/26309.10437] [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: 12/26/2016] [Accepted: 05/25/2017] [Indexed: 11/24/2022]
Abstract
Esthesioneuroblastoma is a rare malignant tumour of the olfactory epithelium. The most common symptom is related to unilateral nasal obstruction. It rarely presents with bilateral proptosis and blindness. We report a 21-month-old girl with esthesioneuroblastoma in sphenoid and ethmoid sinus in a child presenting with bilateral proptosis, blindness, and irritability. The diagnosis was confirmed by histopathology.
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Affiliation(s)
- Mahdi Shahriari
- Associate Professor, Department of Paediatrics, Division of Paediatric Haematology and Oncology, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Nader Shakibazad
- Paediatric Oncology and Haematology Fellow, Department of Paediatrics, Division of Paediatric Haematology and Oncology, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Mehrpour Moradi
- Paediatric Oncology and Haematology Fellow, Department of Paediatrics, Division of Paediatric Haematology and Oncology, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
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Olfactory neuroblastoma: a single-center experience. Neurosurg Rev 2017; 41:323-331. [PMID: 28540633 DOI: 10.1007/s10143-017-0859-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/03/2017] [Accepted: 05/05/2017] [Indexed: 12/21/2022]
Abstract
Olfactory neuroblastoma (ONB) is a potentially curable disease, despite being an aggressive malignancy with a poor natural history. Our goal was to evaluate management outcomes for patients with ONB treated at our institution. Our prospective database for brain tumors and the pathology registry of head and neck cancers at Oslo University Hospital were searched to identify all patients treated for ONB between 1998 and 2016. Variables extracted from these databases, supplemented by retrospective chart reviews, underwent thorough analysis. All cases were formally re-examined by a dedicated head and neck pathologist. Twenty patients were identified. Follow-up was 100%. Mean follow-up was 81.5 months for the entire cohort and 120.3 months for patients with no evidence of disease. Fourteen patients underwent treatment of choice including craniofacial resection (CFR) with or without radiotherapy (XRT). Six patients could only receive less extensive treatment; three patients underwent lateral rhinotomy (LR) with or without XRT after being deemed medically unsuitable for CFR, while another three patients received only supportive, non-surgical treatment (due to positive lymph node status in two and to extensive tumor size in one case). Overall and disease-specific survival rates were 100% after 10 years of follow-up when negative surgical margins were achieved by CFR. Positive margins were associated with poorer outcome with no patients surviving longer than 44 months. Long-term survival was also achieved in two cases among patients not eligible for CFR: one case after radical LR and one case after radio-chemotherapy. Advanced disease at presentation (tumor size ≥40 mm, Kadish grades C and D, or TNM IVa and IVb) and positive surgical margins were correlated to significantly dismal survival. Our study suggests that CFR with or without adjuvant XRT is safe and leads to excellent long-time overall and disease-specific survival. Negative surgical margins, tumor size <40 mm, Kadish stage A/B, and TNM stages I-III are independent prognostic predictors of outcome.
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Proton beam therapy for olfactory neuroblastoma. Radiother Oncol 2017; 122:368-372. [DOI: 10.1016/j.radonc.2016.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/27/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW This article provides a contemporary review of the management of esthesioneuroblastoma (ENB) within the context of recent surgical advancements, while highlighting the ongoing limitations and controversies surrounding this uncommon pathologic entity. RECENT FINDINGS Surgical management of ENB is continuously evolving with contemporary endoscopic approaches complementing or in many cases replacing open approaches. SUMMARY Complete surgical resection remains the mainstay definitive therapy for ENB. Aggressive, combined modality therapy appears to be justified in patients at greatest risk of developing recurrence based on advanced tumor stage and high pathologic grade. ENB requires prolonged surveillance following treatment given its tendency for late recurrence.
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Recurrent Olfactory Neuroblastoma in Remote Leptomeninges, Mimicking Intracranial Meningioma. World Neurosurg 2016; 96:612.e9-612.e14. [PMID: 27609444 DOI: 10.1016/j.wneu.2016.08.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Olfactory neuroblastoma (ONB) is an uncommon neoplasm that arises from olfactory epithelium in the nasal cavity near the cribriform plate. Although local recurrence or direct extension along olfactory epithelium and metastasis to the central nervous system has been reported, remote leptomeningeal metastasis is quite rare. In our report of a leptomeningeal metastasis of ONB without recurrence of primary site, we discuss the possible pathogenesis of this rare phenomenon with a review of the literature. CASE DESCRIPTION A 56-year-old woman was admitted with epistaxis. Magnetic resonance imaging revealed a mass in the right cribriform plate and ethmoid sinus with intracranial extension. She was primarily treated with craniofacial resection followed by radiotherapy. Gross total resection was achieved, but annual follow-up magnetic resonance imaging showed a new enhancing mass in the left parietal meninges mimicking meningioma without local recurrence at 5 years after the first operation. A second operation was performed, and pathologic examination confirmed the lesion as metastatic olfactory neuroblastoma. CONCLUSIONS ONB is a locally aggressive tumor, but it also potentially spreads to remote leptomeninges via blood or cerebrospinal fluid. Therefore, careful evaluation is needed not to misdiagnose a meningioma and delay the treatment. Moreover, understanding the route of remote leptomeningeal metastasis and en-bloc resection of tumor at first operation might reduce leptomeningeal metastasis, irrespective of surgical corridors.
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Lapierre A, Selmaji I, Samlali H, Brahmi T, Yossi S. [Esthesioneuroblastoma: A single institution's experience and general literature review]. Cancer Radiother 2016; 20:783-789. [PMID: 27449859 DOI: 10.1016/j.canrad.2016.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Olfactory neuroblastoma or esthesioneuroblastoma is a rare entity among head and neck neoplasms. In this paper, we report the experience of our institution and compare it with a comprehensive review of the literature. PATIENTS AND METHODS We retrospectively analysed clinical and treatment data of patients referred to the Lyon Sud University Hospital (France) for histologically proven olfactive esthesioneuroblastoma. RESULTS Ten patients treated between 1993 and 2015 have been analysed. Disease stage at diagnosis, according to the Kadish staging system, was C in 90% of cases. Median follow-up was 136 months. Ten-year overall survival was 90%. Five- and ten-year progression-free survival were 70% and 50%. Nine patients (90%) underwent surgical resection first. Seven of the nine patients who underwent resection (77%) received adjuvant three-dimensional (3D)-conformal radiotherapy (n=7), intensity-modulated radiotherapy (n=1), or volumetric arctherapy (n=1). The mean dose to the tumour volume was 61Gy. None of the patients received elective nodal irradiation. Two patients received concurrent chemotherapy. Five patients (50%) presented with disease recurrence, which was local (n=1), nodal (n=2) and cerebral (n=2). CONCLUSION Our results are consistent with the literature. Because of the lack of prospective study and the low number of cases in the literature, each institution's experience is of the utmost important to improve standardised management of these tumours.
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Affiliation(s)
- A Lapierre
- Département de radiothérapie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - I Selmaji
- Département de radiothérapie, centre hospitalier universitaire de Marrakech, Marrakech, Maroc
| | - H Samlali
- Département de radiothérapie, centre hospitalier universitaire de Casablanca, Casablanca, Maroc
| | - T Brahmi
- Département de radiothérapie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - S Yossi
- Département de radiothérapie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Fu TS, Monteiro E, Muhanna N, Goldstein DP, de Almeida JR. Comparison of outcomes for open versus endoscopic approaches for olfactory neuroblastoma: A systematic review and individual participant data meta-analysis. Head Neck 2015; 38 Suppl 1:E2306-16. [PMID: 26514662 DOI: 10.1002/hed.24233] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Endoscopic approaches have been adopted as an alternative to craniofacial resection in the surgical management of olfactory neuroblastoma. METHODS We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, Cochrane, and CINAHL (2000-2014) to compare outcomes for open versus endoscopic approaches. RESULTS Thirty-six studies containing 609 patients were included. Meta-analysis of (a) all patients, (b) Kadish C/D only, and (c) Hyams III/IV only, failed to show a difference in locoregional control and metastasis-free survival between approaches. However, endoscopic approaches were associated with improved overall survival (OS) for all 3 groups (p = .001, .04, and .001, respectively), and higher disease-specific survival (DSS) for all patients (p = .004) and Hyams III/IV only (p = .002). CONCLUSION The current study suggests that endoscopic approaches have comparable control rates to open approaches for olfactory neuroblastoma. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2306-E2316, 2016.
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Affiliation(s)
- Terence S Fu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nidal Muhanna
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Petruzzelli G, Howell J, Pederson A, Origitano T, Byrne R, Munoz L, Emami B, Clark J. Multidisciplinary treatment of olfactory neuroblastoma: Patterns of failure and management of recurrence. Am J Otolaryngol 2015; 36:547-53. [PMID: 25749259 DOI: 10.1016/j.amjoto.2015.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/14/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE Esthesioneuroblastoma is an uncommon malignancy of the head and neck for which there is no defined treatment protocol. The purpose of this study is to report our experience with the treatment and patterns of failure of this disease. METHODS AND MATERIALS From 1994 to 2012, 37 previously unreported patients with esthesioneuroblastoma were evaluated, and 32 eventually treated for cure at 2 academic medical centers. All patients were staged with Kadish criteria. The mean and median follow-ups were 96.1 and 76.5 months respectively (range 6-240 months). RESULTS The Kadish stage was A in 6 patients, B in 13 patients, and C in 13 patients. Four patients were initially treated with concurrent chemo-radiation therapy. Twenty-eight patients were treated with primary surgery. Two (2) underwent open medial maxillectomy and 26 underwent craniofacial resection (open - 17, endoscopic - 9). Three patients received curative surgical resection only. Seven patients failed either within the cranial axis or distantly, 6 of the 7 are dead of disease, 10-194 months following initial treatment. Six patients had isolated neck recurrences, 4/6 were salvaged with neck dissection and additional chemo-radiation and remain alive 30-194 months following initial treatment. Estimated overall survival rate at 10 years was 78% based on Kadish and T stages. CONCLUSION In this retrospective analysis of 32 patients, Kadish stage C and stage T3/T4 tumors were associated with worse outcome. Total radiation dose of 60 Gy, margin status, patient age, were not found to have significant prognostic value.
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Su SY, Bell D, Hanna EY. Esthesioneuroblastoma, neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma: differentiation in diagnosis and treatment. Int Arch Otorhinolaryngol 2015; 18:S149-56. [PMID: 25992139 PMCID: PMC4399581 DOI: 10.1055/s-0034-1390014] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Introduction Malignant sinonasal tumors comprise less than 1% of all neoplasms. A wide variety of tumors occurring primarily in this site can present with an undifferentiated or poorly differentiated morphology. Among them are esthesioneuroblastomas, sinonasal undifferentiated carcinomas, and neuroendocrine carcinomas. Objectives We will discuss diagnostic strategies, recent advances in immunohistochemistry and molecular diagnosis, and treatment strategies. Data Synthesis These lesions are diagnostically challenging, and up to 30% of sinonasal malignancies referred to the University of Texas MD Anderson Cancer Center are given a different diagnosis on review of pathology. Correct classification is vital, as these tumors are significantly different in biological behavior and response to treatment. The past decade has witnessed advances in diagnosis and therapeutic modalities leading to improvements in survival. However, the optimal treatment for esthesioneuroblastoma, sinonasal undifferentiated carcinoma, and neuroendocrine carcinoma remain debated. We discuss advances in immunohistochemistry and molecular diagnosis, diagnostic strategies, and treatment selection. Conclusions There are significant differences in prognosis and treatment for esthesioneuroblastoma, neuroendocrine carcinoma, and sinonasal undifferentiated carcinoma. Recent advances have the potential to improve oncologic outcomes but further investigation in needed.
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Affiliation(s)
- Shirley Y Su
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Diana Bell
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Valdes CJ, Tewfik MA, Guiot MC, Di Maio S. Synchronous esthesioneuroblastoma and growth-hormone-secreting pituitary macroadenoma: combined open and endoscopic management. J Neurol Surg Rep 2014; 75:e194-9. [PMID: 25485212 PMCID: PMC4242820 DOI: 10.1055/s-0034-1372472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 01/24/2014] [Indexed: 11/03/2022] Open
Abstract
Background Esthesioneuroblastoma is an uncommon malignant neoplasm that arises from the olfactory neuroepithelium. In this article we report a case of esthesioneuroblastoma presenting concomitantly with a growth-hormone (GH)-secreting pituitary macroadenoma. Results A 52 year old woman underwent surgery for suspected nasal polyps. Intralesional debulking of an intranasal tumor disclosed a low-grade esthesioneuroblastoma. Magnetic resonance imaging (MRI) demonstrated a large nasal and intracranial tumor, in addition to a separate sellar and suprasellar tumor. The patient was frankly acromegalic. She underwent a first-stage gross total resection of the esthesioneuroblastoma via a combined extended subfrontal and extended endonasal approach, followed by focused radiation therapy. She then returned for endoscopic removal of the GH-secreting pituitary macroadenoma. Conclusion The combined open and endoscopic management of this patient is described and a review of the literature presented. To our knowledge this is the first case of synchronous esthesioneuroblastoma and macroadenoma, in this case GH secreting, described in the literature.
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Affiliation(s)
- Costanza J Valdes
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marc A Tewfik
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marie-Christine Guiot
- Department of Neuropathology, McGill University, Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Salvatore Di Maio
- Division of Neurosurgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
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König MS, Osnes T, Meling TR. Treatment of esthesioneuroblastomas. Neurochirurgie 2014; 60:151-7. [PMID: 24975203 DOI: 10.1016/j.neuchi.2014.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To analyze the clinical features, treatment outcomes, pattern of failures, and course of the disease of a cohort of patients treated for esthesioneuroblastoma (ENB) with craniofacial resection (CFR) at a single institution during a 12-year period. MATERIAL AND METHODS Retrospective analysis of 11 patients with ENB treated with CFR in a tertiary care academic medical center from 1998 to 2009. RESULTS Median age at diagnosis was 51 years (range 41-67 years). The most common presenting symptom was nasal obstruction (91%). Four patients (36%) presented with Kadish stage B, six patients (55%) with Kadish stage C, and one patient (9%) with Kadish stage D. The initial treatment was craniofacial resection (CFR) alone for three patients (23%), CFR followed by postoperative radiation therapy (RT) in seven patients (64%), while one patient (9%) received both neoadjuvant and adjuvant RT in addition to surgery. The mean and median follow-up times were 66 and 58 months, respectively (range 23-158 months). Seven patients are currently alive with no evidence of disease (64%), while two patients are alive with disease (18%). Overall survival was 100% at one year postoperatively and 80% five years after the primary treatment. The progression free survival was calculated to 73% at one year and 64% at five years. CONCLUSIONS ENB is an uncommon diagnosis with an incidence of 0.037/100,000 persons/year in the catchment area of our institution. Treatment can be challenging, especially with advanced disease. CFR with RT offers good oncologic disease control with minimal morbidity.
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Affiliation(s)
- M S König
- Department of neurology, Ostfold hospital trust, 1603 Fredrikstad, Norway.
| | - T Osnes
- Department of otorhinolaryngology, Oslo university hospital, Rikshospitalet, 0027 Oslo, Norway.
| | - T R Meling
- Department of neurosurgery, Oslo university hospital, Rikshospitalet, 0027 Oslo, Norway.
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Ow TJ, Hanna EY, Roberts DB, Levine NB, El-Naggar AK, Rosenthal DI, DeMonte F, Kupferman ME. Optimization of long-term outcomes for patients with esthesioneuroblastoma. Head Neck 2014; 36:524-30. [PMID: 23780581 DOI: 10.1002/hed.23327] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Esthesioneuroblastoma is a rare cancer of the anterior cranial base that arises in the region of the olfactory rootlets. The purpose of this study was to review the long-term outcomes of patients diagnosed with esthesioneuroblastoma (ENB) treated at a single institution to determine factors associated with improved disease control and survival. METHODS A retrospective review of 70 patients with ENB treated at the University of Texas MD Anderson Cancer Center between 1992 and 2007 was undertaken. Survival and recurrence was analyzed and compared using the Kaplan-Meier method and log-rank statistics. RESULTS Seventy patients were reviewed. The majority (77%) had T3 or T4 disease at presentation, 38% identified as modified Kadish stage C or D. Ninety percent of patients received surgical resection as part of their treatment, and 66% received postoperative radiation or chemoradiation. The median follow-up was 91.4 months (7.6 years). Forty-eight percent of patients developed recurrent disease and the median time to recurrence was 6.9 years. Overall and disease-specific median survival was 10.5 and 11.6 years, respectively. Patients who were treated with surgery alone had a median disease-specific survival of 87.9 months, whereas those who were treated with surgery and postoperative radiation had a median disease-specific survival of 218.5 months (p = .047). CONCLUSION Patients with ENB can achieve favorable long-term survival, even if disease is locally advanced. Survival is improved considerably when surgical resection is followed by postoperative radiation. However, recurrence rates and mortality remain high, and therefore long-term observation in these patients is warranted.
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Affiliation(s)
- Thomas J Ow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Karam SD, Jay AK, Anyanwu C, Steehler MK, Davidson B, Debrito P, Harter KW. Pathologic collision of inverted papilloma with esthesioneuroblastoma. Front Oncol 2014; 4:44. [PMID: 24672769 PMCID: PMC3953676 DOI: 10.3389/fonc.2014.00044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/24/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Inverted papilloma (IP) of the nasal cavity is a benign tumor that represents 0.5–4% of all nasal tumors and have been known to rarely undergo malignant transformation to squamous carcinoma and even more rarely adenocarcinoma. Synchronous association with low-grade esthesioneuroblastoma (ENB) has been reported in only one case report where a small-sized lesion was treated with surgery alone. Here we report the first case of invasion of IP by high-grade ENB with nodal metastasis that was treated with combined modality therapy. Case Presentation: A case of a 64-year-old African American gentleman presented to the otolaryngology with a 3-month history of recurrent epistaxis. Imaging revealed a large right nasal cavity mass extending into the right sphenoid sinus but without intracranial extension. Surgical pathology revealed high-grade ENB invading IP. An orbitofrontal craniotomy approach was used to achieve complete resection of the mass but with positive margins. Post-operative positron emission tomography/computed tomography showed nodal metastasis. The patient was then treated with adjuvant chemoradiation and remains without evidence of disease at 42 months post-treatment. We discuss the disease presentation, histopathologic features, and disease management with literature support. Conclusion: In this very rare disease presentation where two extremely rare malignancies collide, we show that aggressive management with trimodality therapy of surgery, adjuvant radiation with stereotactic radiosurgical boost, and adjuvant chemotherapy gives excellent results. Given the natural history of the disease, however, long follow-up is needed to declare complete freedom from the disease.
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Affiliation(s)
- Sana D Karam
- Department of Radiation Oncology, Georgetown University Hospital , Washington, DC , USA
| | - Ann K Jay
- Department of Radiology, Georgetown University Hospital , Washington, DC , USA
| | - Cynthia Anyanwu
- Department of Otolaryngology, Georgetown University Hospital , Washington, DC , USA
| | - Matthew K Steehler
- Department of Otolaryngology, Georgetown University Hospital , Washington, DC , USA
| | - Bruce Davidson
- Department of Otolaryngology, Georgetown University Hospital , Washington, DC , USA
| | - Pedro Debrito
- Department of Pathology, Georgetown University Hospital , Washington, DC , USA
| | - K William Harter
- Department of Radiation Oncology, Georgetown University Hospital , Washington, DC , USA
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Herr MW, Gray ST, Erman AB, Curry WT, Deschler DG, Lin DT. Orbital preservation in patients with esthesioneuroblastoma. J Neurol Surg B Skull Base 2013; 74:142-5. [PMID: 24436904 DOI: 10.1055/s-0033-1338259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022] Open
Abstract
Objectives Surgical resection in addition to adjuvant radiation with or without chemotherapy is the mainstay of treatment for esthesioneuroblastoma (ENB). However, management of patients with orbital involvement remains controversial. Historically, orbital exenteration has been advocated when there is evidence of periorbital invasion. Recently, the indications for orbital exenteration have become more selective and orbital preservation has been advocated. We report our experience with anterior craniofacial resection and orbital preservation in patients with ENB. Design Retrospective review of all patients diagnosed with esthesioneuroblastoma who underwent traditional open anterior craniofacial resection at the Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary Cranial Base Center from 1997 to 2008. Results Sixteen patients were identified with a mean follow-up of 76 months. All patients underwent anterior craniofacial resection via an open approach and adjuvant proton beam radiation. Six of the 16 patients had evidence of either periorbital or lacrimal sac involvement at the time of surgery. All of these patients underwent periorbital resection to negative histologic margins with preservation of the orbit. Conclusion In our study, patients with ENB and periorbital invasion-who were treated with anterior craniofacial resection and periorbital resection with orbital preservation-had no evidence of decreased survival. In all patients, negative histologic margins of the periorbital resection were achieved.
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Affiliation(s)
- Marc W Herr
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, USA
| | - Stacey T Gray
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, USA
| | - Audrey B Erman
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona Cancer Center, Tucson, Arizona, USA
| | - William T Curry
- Department of Neurosurgery, Pappas Center for Neuro-oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, USA
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40
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[Esthesioneuroblastoma]. Bull Cancer 2013; 99:1197-207. [PMID: 23022763 DOI: 10.1684/bdc.2012.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Esthesioneuroblastoma is an uncommon malignancy originating from olfactive epithelium. Men are more frequently affected than women. Nasal symptoms are the most common revealing signs. Immunohistochemistry helps diagnosis. There is no randomized trial evaluating treatment due to the low incidence of this tumor. Radiotherapy and surgery are the standard of care. Radiotherapy is benefic even in early stage disease. Chemotherapy is indicated in case of locally advanced or metastatic disease.
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Abstract
Esthesioneuroblastoma is a rare malignant neoplasm in the olfactory region of the nasal cavity and anterior skull base. Diagnosis and staging require anatomic imaging and careful pathologic assessment. Standard treatment is anterior craniofacial resection with postoperative irradiation. The role for chemotherapy is not defined, but is generally for the most advanced cases and used in the neoadjuvant setting and/or postoperatively with irradiation. Prognosis is favorable; however, metastasis rates remain relatively high. Regional and distant metastasis portends a poor outcome. Intensity-modulated radiation treatment and endoscopic surgery have reduced morbidity, but outcomes with these techniques must be fully evaluated.
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Affiliation(s)
- Thomas J Ow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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42
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Kaur G, Kane AJ, Sughrue ME, Madden M, Oh MC, Sun MZ, Safaee M, El-Sayed I, Aghi M, McDermott MW, Berger MS, Parsa AT. The prognostic implications of Hyam's subtype for patients with Kadish stage C esthesioneuroblastoma. J Clin Neurosci 2012; 20:281-6. [PMID: 23266076 DOI: 10.1016/j.jocn.2012.05.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/12/2012] [Indexed: 10/27/2022]
Abstract
Esthesioneuroblastoma (EN) is a rare sinonasal tumor with varied aggressiveness and potential for intracranial invasion. EN is staged anatomically with radiographic evaluation using the Kadish staging system (stages A, B, and C) and histologically by using Hyam's criteria (grades 1-4). Here we show that despite radiographic evidence of aggressive features, the prognosis of patients with Kadish stage C EN is best predicted by tumor histology using Hyam's criteria. We retrospectively analyzed patients with EN with Kadish stage C who were evaluated and treated at our institution between 1995 and 2009. Clinical information was collected using patient medical records, imaging, and review of pathological specimens. Twenty patients with Kadish stage C EN were identified with mean age of 51 years (31-70 years) with a median follow-up of 41.4 months (1.3-175 months). Upon pathological review, 44.4% of patients had low-grade (1/2) and 55.6% had high-grade (3/4) histology. About 37.5% of patients with low-grade EN had undergone gross total resection (GTR) and the remaining 62.5% had GTR and adjuvant radiation, whereas 50% of patients with high-grade ER had undergone GTR, 20% had undergone GTR and adjuvant radiation, and 30% had been treated with a subtotal resection (STR) and adjuvant radiation. The 5-year and 10-year survival in patients with low-grade EN was 86% in comparison to 56% and 28% with high-grade EN, respectively. In patients with low-grade EN, the 2-year progression free survival (PFS) was 86% and the 5-year PFS was 65% in comparison to 73% and 49% in patients with high-grade EN, respectively. The patient's tumor histology (Hyam's criteria) appeared to be the best way of predicting the prognosis and for selecting patients for adjuvant radiotherapy.
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Affiliation(s)
- Gurvinder Kaur
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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43
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Bak M, Wein RO. Esthesioneuroblastoma: a contemporary review of diagnosis and management. Hematol Oncol Clin North Am 2012; 26:1185-207. [PMID: 23116576 DOI: 10.1016/j.hoc.2012.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Esthesioneuroblastoma (ENB) is a rare malignancy, representing only 3% to 6% of all sinonasal malignancies. A wide array of treatment options for ENB have been described in the literature, but prospective clinical trials are absent given the tumor's rarity and natural history. Delay in diagnosis leading to an initial advanced stage of presentation is common secondary to the clinically hidden primary site at the anterior skull base. This article presents data from the current body of literature and reviews the advocated roles for surgery, radiation therapy and chemotherapy.
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Affiliation(s)
- Matthew Bak
- Eastern Virginia Medical School, Norfolk, VA 23507, USA
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44
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Chernov M, Muragaki Y, Iseki H. Letters to the editor: Esthesioneuroblastoma. J Neurosurg 2012; 117:1206-7. [PMID: 23020767 DOI: 10.3171/2010.12.jns101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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45
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Dunbar EM, Pumphrey PK, Bidari S. Unexpectedly durable palliation of metastatic olfactory neuroblastoma using anti-angiogenic therapy with Bevacizumab. Rare Tumors 2012; 4:e33. [PMID: 22826790 PMCID: PMC3401161 DOI: 10.4081/rt.2012.e33] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 05/10/2012] [Accepted: 05/15/2012] [Indexed: 11/23/2022] Open
Abstract
Olfactory neuroblastomas (ONBs) are rare malignant tumors that arise from olfactory epithelium and typically present with symptoms attributable to locally invasive disease. Kadish radiographic staging and Hyams' histopathologic grading are prognostic. Overall survival rates, averaging 60–70% at 5 years, remain limited by high rates of delayed loco-regional and distant progression. At initial presentation, the available evidence supports the use of multimodality therapy, historically surgery and radiation, to improve disease-free and overall survival. At recurrence/progression, the available evidence supports the use of therapy to improve disease control and symptoms (palliation), but patient heterogeneity dictates individualization of modalities. Although the ideal use of chemotherapy as a modality remains undefined, the available evidence supports it use, historically platinum-based, for palliation. However, recent insights into the molecular-genetic aberrations of ONBs, coupled with the emergence chemotherapeutic agents capable of targeting such aberrations, suggest an expanded role. The authors report a case of a 60 years-old man, heavily pre-treated for metastatic ONB, presenting with profound central-nerve-system and head-and-neck symptoms. He experienced unexpectedly durable palliation with Bevacizumab anti-angiogenic therapy. Additionally, he experienced localized palliation with an Ommaya reservoir. The authors review the literature regarding historical and emerging therapies for ONB to emphasize the needs for individualization and translational-clinical studies.
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Affiliation(s)
- Erin M Dunbar
- Department of Neurosurgery, Preston A. Wells Jr., Center for Brain Tumor Therapy
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The clinical importance of quality-of-life scores in patients with skull base tumors: a meta-analysis and review of the literature. Curr Oncol Rep 2012; 14:175-81. [PMID: 22278770 DOI: 10.1007/s11912-012-0222-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Health-related quality of life (QOL) outcomes are frequently used by clinicians, patients, and researchers for assessing the effectiveness of an intervention. Small differences in QOL may be statistically significant but their clinical relevance remains undefined. The smallest changes in QOL scores of the anterior skull base surgery questionnaire (ASBS-Q) which could be considered clinically significant have not been delineated. Here we present a meta analysis and review of the literature of 273 patients undergoing skull base tumor resection. The minimal clinically important difference (MCID), defined as "the smallest change in QOL which patients perceive as beneficial", was calculated using several statistical approaches. The MCID of the ASBS-Q was 0.4 (8%, score range 1-5). Various other instruments for QOL estimations revealed a larger range of MCID score (between 6.2%-17.5%) for the different QOL domains. The statistical analyses reveal that histology (benign vs malignant), time elapsed from surgery (< or ≥6 months), and surgical approach (open vs endoscopic) have significant clinical impact on different QOL domains. This paper brings level 1b evidence which demonstrates the importance of MCID as an adjunct for estimation of QOL in patients undergoing skull base surgery.
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Demiroz C, Gutfeld O, Aboziada M, Brown D, Marentette LJ, Eisbruch A. Esthesioneuroblastoma: is there a need for elective neck treatment? Int J Radiat Oncol Biol Phys 2011; 81:e255-61. [PMID: 21676553 DOI: 10.1016/j.ijrobp.2011.03.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 02/13/2011] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the risk of cervical lymph node metastases after definitive treatment for esthesioneuroblastoma (ENB) that did not include elective neck therapy. METHODS AND MATERIALS This was a retrospective analysis of 26 ENB patients treated at the University of Michigan between 1995 and 2007. Tumor stage was Kadish A in 1 patient, B in 19, C in 5, and unknown in 1. Craniofacial or subcranial resection was performed in 24 patients (92%), with negative margins in 22 (92%). Postoperative radiotherapy (RT) to the primary site was given in 12 patients (46%), and 14 patients (54%) had surgery alone. All patients had clinically N0 disease, and no patient underwent elective neck dissection or radiation. Median follow-up was 72 months. RESULTS Local relapse-free survival was significantly better for patients who received postoperative RT compared with those who had surgery alone: 100% vs. 29% at 5 years, respectively (p = 0.005). Five-year disease-free survival was 87.5% in the RT group vs. 31% in the surgery-alone group (p = 0.05). Regional failure was observed in 7 patients (27%), 6 with Kadish Stage B and 1 with Stage C disease. The most common site of nodal failure was Level II, and 3 patients failed in the contralateral neck. Only 3 patients with regional failure were successfully salvaged. CONCLUSION The high rate of regional failures when the neck is not electively treated justifies elective nodal RT in patients with both Kadish Stages B and C. In addition, our experience confirms the beneficial effect on local control of adjuvant RT to the tumor bed.
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Affiliation(s)
- Candan Demiroz
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
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Bäck L, Oinas M, Pietarinen-Runtti P, Saarilahti K, Vuola J, Saat R, Öhman J, Haglund C, Niemelä M, Leivo I, Hagström J, Mäkitie AA. The developing management of esthesioneuroblastoma: a single institution experience. Eur Arch Otorhinolaryngol 2011; 269:213-21. [PMID: 21404006 DOI: 10.1007/s00405-011-1568-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 03/04/2011] [Indexed: 11/27/2022]
Abstract
Esthesioneuroblastoma remains a challenging disease because of its rarity, the complexity of surrounding structures, missing opinions of optimal treatment protocol, and complications associated with necessary surgery. Our objective was to analyse the management and outcome of a cohort of patients with esthesioneuroblastoma from 1990 to 2009 in a tertiary medical centre. There were 17 eligible patients (8 males and 9 females) with the median age of 53 years (range 20-75 years). An obvious inconsistency was noted in the management of the various tumours of the present series during the two decades due to a lack of a uniform treatment protocol. The median follow-up time was 57.5 months (range 3-158 months). Nine patients (seven with curative treatment intent) died of the disease with the median time from diagnosis to death of 60 months (range 3-161 months). Eight patients had no evidence of the disease at last follow-up visit (median 76 months, range 24-119 months). Recurrences were documented in seven of the patients. The median time from end of primary treatment to a recurrence was 57 months (range 6-110 months). The 5-year overall survival and disease-free survival was 68 and 62%, respectively. The management of ENB should be planned by an experienced head and neck surgeon as part of a multidisciplinary team in a tertiary referral setting. Multimodality therapy with long-term follow-up is preferable and should be set based on the available disease-specific classifications for clinical staging and histopathological grading.
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Affiliation(s)
- Leif Bäck
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital, University of Helsinki, PO Box 220, 00029 Helsinki, Finland.
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Marsh JC, Garg S, Wendt JA, Gielda BT, Turian JV, Herskovic AM. Intracranial metastatic disease rarely involves the pituitary: retrospective analysis of 935 metastases in 155 patients and review of the literature. Pituitary 2010; 13:260-5. [PMID: 20405323 DOI: 10.1007/s11102-010-0229-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We present a case report of a patient recently treated at our institution for an isolated non-small cell lung cancer metastatic lesion to the sella, report the lack of involvement of the pituitary gland in a large single-institution series of treated intracranial parenchymal metastases, and review the pertinent literature. We reviewed cranial imaging studies (CT and MRI) for 935 metastases in 155 patients treated at our institution over the previous 3 years for intracranial metastatic disease. Special attention was paid to the skull base to document the presence of any metastatic disease involving the pituitary gland, infundibular stalk, sella turcica (including anterior and posterior clinoids), or diaphragm sellae. We found no other involvement of the pituitary gland or other sellar structures by metastatic disease in this series. Intracranial metastatic disease rarely involves the pituitary gland and infundibular stalk parenchyma, suggesting that this structure may be safely omitted from the treatment field during WBRT and prophylactic cranial irradiation (PCI). This treatment approach should reduce the late sequelae of treatment to this critical organ.
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Affiliation(s)
- James C Marsh
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA.
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