Multidisciplinary treatment of olfactory neuroblastoma: Patterns of failure and management of recurrence.
OBJECTIVE
Esthesioneuroblastoma is an uncommon malignancy of the head and neck for which there is no defined treatment protocol. The purpose of this study is to report our experience with the treatment and patterns of failure of this disease.


METHODS
From 1994 to 2012, 37 previously unreported patients with esthesioneuroblastoma were evaluated, and 32 eventually treated for cure at 2 academic medical centers. All patients were staged with Kadish criteria. The mean and median follow-ups were 96.1 and 76.5 months respectively (range 6-240 months).


RESULTS
The Kadish stage was A in 6 patients, B in 13 patients, and C in 13 patients. Four patients were initially treated with concurrent chemo-radiation therapy. Twenty-eight patients were treated with primary surgery. Two (2) underwent open medial maxillectomy and 26 underwent craniofacial resection (open - 17, endoscopic - 9). Three patients received curative surgical resection only. Seven patients failed either within the cranial axis or distantly, 6 of the 7 are dead of disease, 10-194 months following initial treatment. Six patients had isolated neck recurrences, 4/6 were salvaged with neck dissection and additional chemo-radiation and remain alive 30-194 months following initial treatment. Estimated overall survival rate at 10 years was 78% based on Kadish and T stages.


CONCLUSIONS
In this retrospective analysis of 32 patients, Kadish stage C and stage T3/T4 tumors were associated with worse outcome. Total radiation dose of 60 Gy, margin status, patient age, were not found to have significant prognostic value.
Curtis & Elizabeth Anderson Cancer Institute, Memorial University Medical Center Savannah GA. Electronic address: guypetruzzelli@memorialhealth.com.
G J
GJ
Petruzzelli
Georgia Regent's University School of Medicine, Augusta GA.
J B
JB
Howell
Curtis & Elizabeth Anderson Cancer Institute, Memorial University Medical Center Savannah GA.
A
A
Pederson
Neurosciences and Spine Institute: Department of Neurological Surgery, Kalispell Regional Healthcare, Kalispell, MN.
T C
TC
Origitano
Department of Neurosurgery, Rush University Medical Center, Chicago, IL.
R W
RW
Byrne
Department of Neurosurgery, Rush University Medical Center, Chicago, IL.
L
L
Munoz
Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL.
B
B
Emami
Division of Hematology-Oncology, Department of Medicine, Loyola University Medical Center, Maywood IL.
J I
JI
Clark
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D018304:Esthesioneuroblastoma, Olfactory / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology