title: Stereotactic radiosurgical salvage treatment for locally recurrent esthesioneuroblastoma.
abstract: BACKGROUND
  Esthesioneuroblastoma (ENB) is a rare malignant neuroendocrine tumor considered to be radiation sensitive. Local recurrence may be treated in a variety of ways, including stereotactic radiosurgery (SRS); however, little information on its effectiveness is available.
  
  
  OBJECTIVE
  To determine whether SRS is effective in providing local control for recurrent ENB.
  
  
  METHODS
  This was a retrospective single-institution experience including 109 patients with ENB treated at the Mayo Clinic (1962-2009). Sixty-three patients presented with Kadish stage C disease, and 21 patients developed local recurrence. Of these 21 patients, 7 patients underwent SRS at our institution and an additional patient underwent SRS after transnasal biopsy. Therefore, a total of 8 patients are reported.
  
  
  RESULTS
  The median age at time of local recurrence was 50 years. All patients had Kadish C disease at initial diagnosis. Six of 8 patients were found to have Hyams grade 3 disease; the remaining 2 patients had grade 2 disease. The median treatment volume was 8.4 cm (mean, 18.9 cm; range, 1.4-76.3 cm), and the median dose to the tumor margin was 15 Gy (mean, 14.4 ± 2.2 Gy; range, 10-18 Gy). Of the 16 treatments, 13 had adequate follow-up to assess treatment response, with 92% achieving local control over a median follow-up of 42 months from the time of SRS. Five lesions decreased in size, 7 lesions stabilized, and only 1 lesion had in-field progression. There were no documented complications secondary to SRS.
  
  
  CONCLUSIONS
  SRS appears to be a reasonable and safe option for treatment of intracranial recurrence of ENB.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota 55905, USA. vangompel.jamie@mayo.edu
authors.forename: Jamie J
authors.initials: JJ
authors.lastname: Van Gompel
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Carlson
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Pollock
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
authors.forename: Robert L
authors.initials: RL
authors.lastname: Foote
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Link
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001932:Brain Neoplasms / Q000601:surgery*; D018304:Esthesioneuroblastoma, Olfactory / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome