title: Multimodal treatment and long-term outcome of patients with esthesioneuroblastoma.
abstract: OBJECTIVE
  To analyze the clinical features, treatment modalities and outcome of patients treated for a localized esthesioneuroblastoma (ENB).
  
  
  METHODS
  Forty-three consecutive patients with biopsy proven ENB treated at two referral cancer centers between 1998 and 2010 were retrospectively reviewed.
  
  
  RESULTS
  Overall, 5 patients had stage A disease, 13 stage B, 16 stage C and 9 stage D according to the modified Kadish classification. Neo-adjuvant chemotherapy was performed in 23 patients leading to a 74 % response rate. Thirty-one patients were treated by surgery. Thirty-nine patients (90.6%) underwent radiation therapy. Twelve patients received bilateral cervical lymph node irradiation (LNI). After a median follow-up of 77 months, the 5-year overall and progression free survival were 65% and 57%. Twelve patients (28%) had a locoregional relapse leading to 10 ENB-related deaths. The major prognostic factor was the modified Kadish stage with a 3-year survival for stage A-B, C and D of 100%, 48% and 22% respectively (p < 0.0001). Two (9%) isolated cervical lymph node relapses occurred among staged B and C patients treated without elective LNI and none after elective or adjuvant LNI.
  
  
  CONCLUSIONS
  The high risk of locoregional failure in ENB justifies the use of multimodal therapy. Induction chemotherapy leads to a high response rate. Elective LNI might prevent regional failure in locally advanced disease.
authors.affiliation: Institut Gustave Roussy, Department of Radiation Oncology, 114 rue Edouard-Vaillant, 94805 Villejuif, France. Modesto.anouchka@claudiusregaud.fr
authors.forename: A
authors.initials: A
authors.lastname: Modesto
authors.forename: P
authors.initials: P
authors.lastname: Blanchard
authors.forename: Y G
authors.initials: YG
authors.lastname: Tao
authors.forename: M
authors.initials: M
authors.lastname: Rives
authors.forename: F
authors.initials: F
authors.lastname: Janot
authors.forename: E
authors.initials: E
authors.lastname: Serrano
authors.forename: A
authors.initials: A
authors.lastname: Benlyazid
authors.forename: J
authors.initials: J
authors.lastname: Guigay
authors.forename: F R
authors.initials: FR
authors.lastname: Ferrand
authors.forename: J P
authors.initials: JP
authors.lastname: Delord
authors.forename: J
authors.initials: J
authors.lastname: Bourhis
authors.forename: N
authors.initials: N
authors.lastname: Daly-Schveitzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018304:Esthesioneuroblastoma, Olfactory / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Concurrent chemotherapy; Elective neck irradiation; Esthesioneuroblastoma; Intensity Modulated Radiation Therapy; Neo-adjuvant chemotherapy; Olfactory neuroblastoma