title: Radiation therapy for esthesioneuroblastoma: rationale for elective neck irradiation.
abstract: OBJECTIVE
  Esthesioneuroblastoma is an uncommon malignancy of neural crest origin arising in the upper nasal cavity. We describe the University of Florida experience using radiation therapy (RT) in the treatment of this neoplasm, particularly the use of elective nodal irradiation.
  
  
  METHODS
  Between May 1972 and August 1998, 22 patients received RT for esthesioneuroblastoma. Two additional patients were treated with palliative intent and were excluded from analysis. Equal numbers of male and female patients were treated, with a median age of 54 years (range, 3-82). The modified Kadish stage was A in 1 patient, B in 4 patients, C in 15 patients, and D in 2 patients. Treatment modalities included primary RT in 6 patients, preoperative RT in 1 patient, postoperative RT after craniofacial resection in 12 patients, and salvage RT in 3 patients treated for recurrence after surgery. Elective neck RT was performed in 11 of 20 patients; 2 patients had cervical metastases at presentation for RT.
  
  
  RESULTS
  Rates of local control, cause-specific survival, and absolute survival at 5 years were 59%, 54%, and 48%, respectively. The cause-specific survival rate at 5 years was lower after primary RT (17%) than after craniofacial resection and postoperative RT (56%). Cervical metastases occurred in 6 of 22 patients (27%). No neck recurrences occurred in 11 patients treated with elective neck RT compared with 4 neck recurrences in 9 patients (44%) not receiving elective neck RT (p =.02).
  
  
  CONCLUSIONS
  Combined modality therapy is preferred over RT alone in advanced-stage esthesioneuroblastoma. Our data and review of the current literature suggest a higher cervical failure rate than previously recognized. Elective neck RT seems to correlate with improved nodal control and should be considered in the treatment of esthesioneuroblastoma.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, P.O. Box 100385, Gainesville, Florida 32610-0385, USA.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Monroe
authors.forename: Russell W
authors.initials: RW
authors.lastname: Hinerman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology; D001859:Bone Neoplasms / Q000556:secondary; D016190:Carboplatin / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D015251:Epirubicin / Q000627:therapeutic use; D018304:Esthesioneuroblastoma, Olfactory / Q000473:pathology / Q000628:therapy*; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000473:pathology / Q000601:surgery*; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D009669:Nose Neoplasms / Q000473:pathology / Q000628:therapy*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D016879:Salvage Therapy; D013120:Spinal Cord Neoplasms / Q000556:secondary; D016019:Survival Analysis
chemical_list: D003561:Cytarabine; D015251:Epirubicin; D005047:Etoposide; D016190:Carboplatin; D002945:Cisplatin