Esthesioneuroblastoma: an update on the massachusetts eye and ear infirmary and massachusetts general hospital experience with craniofacial resection, proton beam radiation, and chemotherapy.
Objectives To update the Massachusetts General Hospital (MGH) and Massachusetts Eye and Ear Infirmary (MEEI) experience in the management of esthesioneuroblastoma (ENB) with multimodality therapy and to reassess treatment outcomes and complications in a larger cohort with longer follow-up times. Design A retrospective chart review. Setting A tertiary referral center. Participants All patients presenting with ENB and managed at the MGH and MEEI from 1997 to 2013. Main Outcome Measures Disease-free and overall survival. Results Twenty-two patients were identified with an average follow-up of 73 months. Ten patients presented with Kadish stage B disease and 12 with stage C disease. A total of six patients (27%) developed regional metastases. Treatment for all patients included craniofacial resection (CFR) followed by proton beam irradiation with or without chemotherapy. The 5-year disease-free and overall survival rates were 86.4% and 95.2%, respectively, by Kaplan-Meier analysis. Negative margins were a significant factor in disease-free survival. One patient experienced severe late-radiation toxicity. Conclusions ENB is safely and effectively treated with CFR followed by proton beam irradiation. The high incidence of regional metastases warrants strong consideration for elective neck irradiation. Proton beam radiation is associated with lower rates of severe late-radiation toxicity than conventional radiotherapy.
Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States.
Marc W
MW
Herr
Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States.
Rosh K V
RK
Sethi
Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States.
Joshua C
JC
Meier
Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.
Kyle J
KJ
Chambers
Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.
Aaron
A
Remenschneider
Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States ; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, United States.
Annie
A
Chan
Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States ; Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States.
William T
WT
Curry
Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States ; Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States.
Fred G
FG
Barker
Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.
Daniel G
DG
Deschler
Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States.
Derrick T
DT
Lin
craniofacial resection; esthesioneuroblastoma; proton beam radiation; sinonasal malignancy