title: Spread patterns of lymph nodes and the value of elective neck irradiation for esthesioneuroblastoma.
abstract: OBJECTIVE
  This study was aimed to characterize patterns of lymphatic spread and assess the value of prophylactic elective neck irradiation (ENI) for esthesioneuroblastoma (ENB).
  
  
  METHODS
  A retrospectively analysis of 116 patients with newly diagnosed ENB at our institution over 35-year period was undertaken.
  
  
  RESULTS
  32 patients (28%) presented lymph node metastasis at initial diagnosis, the common sites involved were level II, Ib, level III and VIIa. Among 80 N-negative patients staged in Modified Kadish B/C, 50 patients were delivered with ENI, 30 patients were not. The 5-year regional failure-free survival was 98% in patients treated with ENI and 75% in patients without ENI (p=0.005), regional failure rate decreased significantly from 23% (7/30) to 2% (1/50) after ENI (p=0.002). Multivariate analysis also suggested that ENI was an independent favorable predictor for regional controlling (HR, 0.102; 95% CI: 0.012-0.848; p=0.035).
  
  
  CONCLUSIONS
  This is the largest cohort of ENB so far in a single institute, and also the first detailed description of nodal spread patterns of N-positive ENB. Elective neck irradiation reduced the regional failure significantly and should be recommended as a part of initial treatment strategy for patients staged with Modified Kadish B/C.
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Zhen-zhen
authors.initials: ZZ
authors.lastname: Yin
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. Electronic address: jingwei-luo@outlook.com.
authors.forename: Jing-wei
authors.initials: JW
authors.lastname: Luo
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Jun-lin
authors.initials: JL
authors.lastname: Yi
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Xiao-dong
authors.initials: XD
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Qu
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Shi-ping
authors.initials: SP
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Jian-ping
authors.initials: JP
authors.lastname: Xiao
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Guo-zhen
authors.initials: GZ
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Ye-xiong
authors.initials: YX
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D018304:Esthesioneuroblastoma, Olfactory / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D009669:Nose Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Elective neck irradiation; Esthesioneuroblastoma; Failure pattern; Node metastases; Regional spread pattern