Abstract
Objectives: To evaluate efficacy and safety of intensity-modulated radiotherapy (IMRT) in the management of esthesioneuroblastoma (ENB).Methods and Materials: A retrospectively analysis of 52 ENB patients treated with IMRT between 8/2008 and 8/2018 was performed. Thirteen of the 44 patients (29.5%) with newly diagnosed and 2 of the 8 patients with recurrent disease presented regional lymph node metastasis. The median dose of IMRT was 66 (range 52.5–75) Gy for all patients. Elective nodal irradiation (ENI) was provided to all excluding 6 patients in this cohort.Results: With a median follow-up time of 32.5 (6~121) months, the 3-year overall survival (OS), progression-free survival (PFS), local progression-free survival (LPFS), regional progression-free survival (RPFS), and distant metastasis-free survival (DMFS) rates for the entire cohort were 89.7, 69.5, 89.7, 95.1, and 85.4%, respectively. Multivariate analysis revealed that N-classification (N– vs. N+) at presentation was the only significant prognosticators for PFS. No significant prognosticator was identified for other survival outcome. No severe (i.e., grade 3 or 4) IMRT-induced acute toxicity was observed. Severe late toxicities were infrequent (11.5%), which included dysosmia (3.8%), hearing loss (3.8%), radiation brain injury (1.9%), and temporal lobe necrosis (1.9%). Moreover, late ocular toxicity secondary to IMRT was not observed.Conclusion: IMRT produced acceptable 3-year outcomes in terms of OS (89.7%), LPFS (89.7%), and RPFS (95.1%) rates without substantial late adverse effects. Further investigations for a more effective systemic strategy for distant disease control as well as a precision radiation technique for further improvement in local control are needed.
Highlights
Esthesioneuroblastoma (ENB), known as olfactory neuroblastoma, is an uncommon malignancy of neuroectodermal origin and constitutes 3% of all intranasal neoplasms [1]
The neck nodal stations were classified according to the DAHANCA, EORTC, GORTEC, NCIC, and Radiation Therapy Oncology Group (RTOG) consensus [12]
One patient presented with skip metastasis, and the remaining presented in a contiguous pattern
Summary
Esthesioneuroblastoma (ENB), known as olfactory neuroblastoma, is an uncommon malignancy of neuroectodermal origin and constitutes 3% of all intranasal neoplasms [1]. Surgery is generally accepted as the initial treatment of choice, complete resection with sufficient margins is often challenging due to the anatomical location of ENB. Either with definitive (radiotherapy exclusively or radiochemotherapy) or adjuvant intention, is a vital component of the multidiscipline management of the disease. Results of retrospective series has demonstrated that adjuvant radiotherapy after surgery was effective in improving local control [2,3,4,5,6,7]. High-dose radiotherapy offers the only potential for cure for unresectable or inoperable ENB, and may provide similar outcome as compared to surgery for early stage diseases [6]. The dose of radiation is usually limited by critical organs at risk (OARs) usually within the radiation field, especially for locally advanced ENB with intracranial extension
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