Salvage treatment of late neck metastasis in esthesioneuroblastoma: a meta-analysis.
OBJECTIVE
Esthesioneuroblastoma (ENB) is an uncommon tumor of the sinonasal region with a 20% rate of neck metastases. To our knowledge, the rate of neck metastases occurring 6 or more months after diagnosis has not been well characterized. The rate of successful salvage of these late neck metastases, defined in this study as disease-free survival for at least 1 year, has not been previously reported.


METHODS
Meta-analysis examining 33 articles published since 1990.


METHODS
A total of 678 patients with ENB with 79 patients with neck metastases occurring 6 or more months after the initial diagnosis.


METHODS
Patients were grouped according to treatment with surgery, radiotherapy, or combined surgery and radiotherapy.


METHODS
The rate of successful salvage of late neck metastases, defined as disease-free survival for at least 1 year, was compared for the 3 treatment groups.


RESULTS
The rate of cervical metastases was 20.2%, with a 12.4% rate of late neck metastases. The combined successful salvage rate for late neck metastases with surgery, radiation, or combined therapy was 31.2%. An odds ratio (OR) analysis revealed that surgery plus radiation provided a statistically significant increase in the rate of successful salvage in patients with late neck metastases, with an OR of 8.6 vs single modality therapy and a number-needed-to-treat of 3. We found no difference in the OR for successful salvage for surgery alone vs radiation alone (OR, 1.5).


CONCLUSIONS
Treatment of neck metastases occurring 6 or more months after an initial diagnosis of ENB with combined surgery and radiotherapy provides a statistically significant survival advantage vs single-modality therapy.
Gore
Mitchell R
MR
Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7070, USA.
Zanation
Adam M
AM
D018304:Esthesioneuroblastoma, Olfactory / Q000473:pathology*; D006258:Head and Neck Neoplasms / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D009296:Nasal Cavity / Q000473:pathology*; D009669:Nose Neoplasms / Q000473:pathology*; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome