title: Craniofacial surgery for esthesioneuroblastoma: report of an international collaborative study.
abstract: Introduction Impact of treatment and prognostic indicators of outcome are relatively ill-defined in esthesioneuroblastomas (ENB) because of the rarity of these tumors. This study was undertaken to assess the impact of craniofacial resection (CFR) on outcome of ENB. Patients and Methods Data on 151 patients who underwent CFR for ENB were collected from 17 institutions that participated in an international collaborative study. Patient, tumor, treatment, and outcome data were collected by questionnaires and variables were analyzed for prognostic impact on overall, disease-specific and recurrence-free survival. The majority of tumors were staged Kadish stage C (116 or 77%). Overall, 90 patients (60%) had received treatment before CFR, radiation therapy in 51 (34%), and chemotherapy in 23 (15%). The margins of surgical resection were reported positive in 23 (15%) patients. Adjuvant postoperative radiation therapy was used in 51 (34%) and chemotherapy in 9 (6%) patients. Results Treatment-related complications were reported in 49 (32%) patients. With a median follow-up of 56 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 78, 83, and 64%, respectively. Intracranial extension of the disease and positive surgical margins were independent predictors of worse overall, disease-specific, and recurrence-free survival on multivariate analysis. Conclusion This collaborative study of patients treated at various institutions across the world demonstrates the efficacy of CFR for ENB. Intracranial extension of disease and complete surgical excision were independent prognostic predictors of outcome.
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: Bhuvanesh
authors.initials: B
authors.lastname: Singh
authors.forename: Hilda E
authors.initials: HE
authors.lastname: Stambuk
authors.forename: Diane
authors.initials: D
authors.lastname: Carlson
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Bridger
authors.forename: Giulio
authors.initials: G
authors.lastname: Cantu
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Cheesman
authors.forename: Paul
authors.initials: P
authors.lastname: Donald
authors.forename: Dan
authors.initials: D
authors.lastname: Fliss
authors.forename: Patrick
authors.initials: P
authors.lastname: Gullane
authors.forename: Shin-Etsu
authors.initials: SE
authors.lastname: Kamata
authors.forename: Ivo
authors.initials: I
authors.lastname: Janecka
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.forename: Paul A
authors.initials: PA
authors.lastname: Levine
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Medina
authors.forename: Sultan
authors.initials: S
authors.lastname: Pradhan
authors.forename: Victor
authors.initials: V
authors.lastname: Schramm
authors.forename: Carl
authors.initials: C
authors.lastname: Snyderman
authors.forename: William I
authors.initials: WI
authors.lastname: Wei
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
keywords: adjuvant; combined modality therapy; esthesioneuroblastoma; nose neoplasms/mortality/pathology/surgery/*therapy; olfactory/*therapy; radiotherapy; survival analysis