title: Successful treatment of esthesioneuroblastoma and neuroendocrine carcinoma with combined chemotherapy and proton radiation. Results in 9 cases.
abstract: OBJECTIVE
  To study the efficacy of a newly designed treatment strategy for esthesioneuroblastoma and neuroendocrine carcinoma of the paranasal sinuses.
  
  
  METHODS
  Nonrandomized prospective study of a case series in a tertiary referral center.
  
  
  METHODS
  Nine consecutive patients with newly diagnosed esthesioneuroblastoma or neuroendocrine carcinoma of the paranasal sinuses from June 1992 to October 1995 underwent this treatment protocol.
  
  
  METHODS
  After histological diagnosis and detailed imaging, 2 cycles of cisplatin and etoposide chemotherapy were instituted. Chemotherapy responders were treated with combined photon and stereotaxic fractionated proton radiation therapy totaling approximately 68 Gy to the primary site, whereas poor responders were treated with surgical resection followed by postoperative radiation. In both cases, therapy was then concluded with 2 additional cycles of cisplatin and etoposide chemotherapy.
  
  
  METHODS
  Response to therapy, survival, disease-free survival, and complications of therapy were examined.
  
  
  RESULTS
  Nine patients with a median Dulguerov T stage of T3 (range, T2 to T4) completed the treatment protocol, with mean follow-up after diagnosis of 20.5 months. Eight of 9 patients exhibited a dramatic response to therapy with remission of their tumor, and resection was not required. One patient failed to respond to induction chemotherapy and received surgical therapy to be followed by postoperative radiotherapy. There have been no recurrences (mean disease-free interval of 14.0 months). Complications were limited and generally transient.
  
  
  CONCLUSIONS
  The use of combined cisplatin and etoposide chemotherapy with proton radiation has demonstrated initial success in treatment of these tumors. Dramatic response from chemotherapy is possible even in bulky or unresectable disease. This protocol has an acceptable complication rate and conveys less morbidity than craniofacial resection and conventional radiotherapy. Further follow-up will be required to determine the long-term success rate of this therapeutic protocol.
authors.affiliation: Department of Otolaryngology, Massachusetts, Eye & Ear Infirmary and Harvard Medical School, Boston, USA.
authors.forename: N
authors.initials: N
authors.lastname: Bhattacharyya
authors.forename: A F
authors.initials: AF
authors.lastname: Thornton
authors.forename: M P
authors.initials: MP
authors.lastname: Joseph
authors.forename: M L
authors.initials: ML
authors.lastname: Goodman
authors.forename: P C
authors.initials: PC
authors.lastname: Amrein
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018304:Esthesioneuroblastoma, Olfactory / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D002945:Cisplatin