title: Esthesioneuroblastoma: the impact of treatment modality.
abstract: BACKGROUND
  We evaluated the impact of treatment modality on esthesioneuroblastoma.
  
  
  METHODS
  Between 1976 and 1996, 25 patients with esthesioneuroblastoma were treated at Mallinckrodt Institute of Radiology. There were 11 male and 14 female patients; their ages ranged from 16 to 73 years (median, 57 years). The tumors were Kadish stage A in 3, Stage B in 13, C in 8, and modified D in 1 (cervical nodal metastasis). Seventeen patients were treated with surgery and radiation therapy, six were treated with irradiation alone, and two were treated with surgery only. Eight patients received neoadjuvant chemotherapy. Median follow-up was 8 years (range, 2-24 years).
  
  
  RESULTS
  The 5-year actuarial overall survival, disease-free survival, and local tumor control rates were 66.3%, 56.3%, and 73.0%, respectively. Kadish stage was not a significant prognosticator for local control or disease-free survival. Five-year local control rates were 87.4% for the combination of surgery and radiation therapy and 51.2% for irradiation alone. Two patients with Kadish stage A and B disease underwent surgical resection alone; both failed locally. In contrast, 33.3% of patients (three of nine) with Kadish stage A or B disease who received adjuvant radiation therapy had a local recurrence develop. With adjuvant radiation therapy, the surgical margin status did not influence local tumor control. Among the eight patients who received neoadjuvant chemotherapy, six patients showed no response, one had partial response, and one showed a complete response.
  
  
  CONCLUSIONS
  Surgical resection plus adjuvant radiation therapy yielded the best treatment outcome. More effective chemotherapy agents with a reproducible effectiveness are needed for patients with locally advanced esthesioneuroblastoma.
authors.affiliation: Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University Medical Center, WU Box 8224, 4939 Children's Place, Suite 5500, St. Louis, MO 63110, USA. chao@radonc.wustl.edu
authors.forename: K S
authors.initials: KS
authors.lastname: Chao
authors.forename: C
authors.initials: C
authors.lastname: Kaplan
authors.forename: J R
authors.initials: JR
authors.lastname: Simpson
authors.forename: B
authors.initials: B
authors.lastname: Haughey
authors.forename: G J
authors.initials: GJ
authors.lastname: Spector
authors.forename: D G
authors.initials: DG
authors.lastname: Sessions
authors.forename: M
authors.initials: M
authors.lastname: Arquette
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018304:Esthesioneuroblastoma, Olfactory / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods; D009669:Nose Neoplasms / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents