title: The role of elective nodal irradiation for esthesioneuroblastoma patients with clinically negative neck.
abstract: OBJECTIVE
  Although adjuvant radiation to the tumor bed has been reported to improve the clinic outcomes of esthesioneuroblastoma (ENB) patients, the role of elective neck irradiation (ENI) in clinically node-negative (N0) patients remains controversial. Here, we evaluated the effects of ENI on neck nodal relapse risk in ENB patients treated with radiation therapy as a component of multimodality treatment.
  
  
  METHODS
  Seventy-one N0 ENB patients irradiated at the University of Texas MD Anderson Cancer Center between 1970 and 2013 were identified. ENI was performed on 22 of these patients (31%). Survival analysis was performed with focus on comparative outcomes of those patients who did and did not receive ENI.
  
  
  RESULTS
  The median follow-up time for our cohort is 80.8 months (range, 6-350 months). Among N0 patients, 13 (18.3%) developed neck nodal relapses, with a median time to progression of 62.5 months. None of these 13 patients received prophylactic neck irradiation. ENI was associated with significantly improved regional nodal control at 5 years (regional control rate of 100% for ENI vs 82%, P < .001), but not overall survival or disease-free survival. Eleven patients without ENI developed isolated neck recurrences. All had further treatment for their neck disease, including neck dissection (n = 10), radiation (n = 10), or chemotherapy (n = 5). Six of these 11 patients (54.5%) demonstrated no evidence of further recurrence with a median follow-up of 55.5 months.
  
  
  CONCLUSIONS
  ENI significantly reduces the risk of cervical nodal recurrence in ENB patients with clinically N0 neck, but this did not translate to a survival benefit. Multimodality treatment for isolated neck recurrence provides a reasonable salvage rate. The greatest benefit for ENI appeared to be among younger patients who presented with Kadish C disease. Further studies are needed to confirm these findings.
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Wen
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt.
authors.forename: Abdallah S R
authors.initials: ASR
authors.lastname: Mohamed
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Clifton David
authors.initials: CD
authors.lastname: Fuller
authors.affiliation: Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida.
authors.forename: Betty Y S
authors.initials: BYS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Chad
authors.initials: C
authors.lastname: Tang
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: G Brandon
authors.initials: GB
authors.lastname: Gunn
authors.affiliation: Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ehab Y
authors.initials: EY
authors.lastname: Hanna
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.affiliation: Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Shirley Y
authors.initials: SY
authors.lastname: Su
authors.affiliation: Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Diaz
authors.affiliation: Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kupferman
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Heath
authors.initials: H
authors.lastname: Skinner
authors.affiliation: Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Lai
authors.affiliation: Department of Pathology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Adel K
authors.initials: AK
authors.lastname: El-Naggar
authors.affiliation: Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Franco
authors.initials: F
authors.lastname: DeMonte
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: agarden@mdanderson.org.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: jphan@mdanderson.org.
authors.forename: Jack
authors.initials: J
authors.lastname: Phan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018304:Esthesioneuroblastoma, Olfactory / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D055815:Young Adult