title: Olfactory Neuroblastoma: Fate of the Neck--A Long-term Multicenter Retrospective Study.
abstract: OBJECTIVE
  Olfactory neuroblastoma and the management of neck disease has posed considerable challenges to the treating physician. The aims of the study were to determine the incidence and factors influencing neck disease and to identify at-risk patients with cervical node-negative disease at presentation.
  
  
  METHODS
  Multicenter case series with retrospective chart review.
  
  
  METHODS
  In sum, 113 patients with a histopathologic diagnosis of olfactory neuroblastoma across 6 tertiary hospitals in Australia and the United States.
  
  
  METHODS
  Treatment modalities for the primary site and neck included surgery, radiotherapy, and combined therapy. Treatment outcomes were measured in relation to date of primary treatment, and long-term follow-up was recorded. Disease-free survival was calculated as time for patients to develop delayed neck disease following primary treatment.
  
  
  RESULTS
  A total of 113 patients (46 females, 49.7 ± 13.2 years) were identified with a median follow-up of 41.5 months (interquartile range, 58.2); 7.1% of patients presented with primary neck disease, while 8.8% of patients presented with delayed neck disease. Neck disease was present in patients with Hyams grade II (22.2%), III (55.6%), and IV (22.2%) lesions (χ(2) = 5.66, P = .13). Histologic grade was higher in patients with primary neck disease (χ(2) = 16.22, P = .001). Positive surgical margins were associated with a higher risk of delayed neck disease as compared with clear surgical margin (17.9% vs 5%, P = .034).
  
  
  CONCLUSIONS
  Neck metastasis is an important clinical consideration for olfactory neuroblastoma at presentation and in surveillance. Primary treatment of the neck could be considered in select patients. Long-term surveillance of the neck and primary site is essential.
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia Rhinology and Skull Base Research Group, Applied Medical Research Centre, St Vincent's Hospital, University of New South Wales, Sydney, Australia sunny99@gmail.com.
authors.forename: Sunny B
authors.initials: SB
authors.lastname: Nalavenkata
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia Department of Otolaryngology, Concord General Hospital, Sydney, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Sacks
authors.affiliation: Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
authors.forename: Nithin D
authors.initials: ND
authors.lastname: Adappa
authors.affiliation: Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
authors.affiliation: California Sinus Centers, San Jose, California, United States.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Purkey
authors.affiliation: Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Feldman
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Snyderman
authors.affiliation: Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, United States.
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Woodworth
authors.affiliation: Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Smee
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Prince of Wales and Sydney Hospitals, Sydney, Australia.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Havas
authors.affiliation: Rhinology and Skull Base Research Group, Applied Medical Research Centre, St Vincent's Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Gallagher
authors.affiliation: Rhinology and Skull Base Research Group, Applied Medical Research Centre, St Vincent's Hospital, University of New South Wales, Sydney, Australia Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
mesh_terms: D001315:Australia / Q000453:epidemiology; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D018304:Esthesioneuroblastoma, Olfactory / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity; D009333:Neck; D009669:Nose Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: endoscopy; esthesioneuroblastoma; lymphatic metastases; neck; radiotherapy; surgery