Objective
To define the incidence and risk factors of metastatic disease, and the effectiveness of salvage therapy, in esthesioneuroblastoma (ENB).
Study Design
Retrospective analysis of 57 patients presenting from 1979 through 2009.
Methods
Cumulative incidence of neck failure, distant failure and survival were assessed using the Kaplan-Meier method.
Results
Overall survival for all patients was 85% at 5 years and 75% at 10 years. Overall survival was negatively impacted by intracranial tumor extension (p<0.001), positive resection margins (p=0.05), and neck metastases (p=0.017). Neck lymph nodes were not electively irradiated during this time period. Nodal metastases developed in 17% of patients at a median time of 60 months. Kadish stage was not associated with risk of nodal metastasis (p=0.78). After treatment for nodal recurrence, locoregional control was achieved in 78% of patients. Of patients developing nodal recurrence, more than half developed distant metastases. The cumulative incidence of distant metastasis was 39% at a median time of 40 months. Patients who presented with Kadish stage C or D had a significantly increased risk of distant failure (p<0.001). In patients developing nodal (p=0.017) or distant metastasis (p=0.001) the probability of survival was significantly decreased.
Conclusion
Regional and distant metastases in patients with esthesioneuroblastoma occur in a delayed fashion and negatively impact survival. Neck nodal recurrence may be a harbinger of distant metastases. At MSKCC we now treat the majority of ENB patients with elective nodal irradiation. However, the chief obstacle to long-term cure is distant metastases.
Purpose of Review
To discuss and review the role for elective treatment of the neck in maxillary squamous cell carcinoma. Improvements in survival have been seen due to improved local therapies and control, therefore the treatment of the neck has become a topic of debate.
Recent findings
The risk of occult metastases in neck nodes is higher for T 3-4 tumors. The rate of nodal relapse in the N0 neck without elective treatment is 8-15%. With elective irradiation the nodal relapse rate decreases. However, most nodal relapses are accompanied by local failure or distant disease. Local failure remains the most common site of failure and cause of death in this patient population.
Summary
Treatment failure occurs overall in 62% of all patients, with local recurrence by far the most common site of treatment failure which is rarely amenable to salvage therapy. Therefore elective neck irradiation is not routinely indicated in the clinically N0 neck; those who recur only in the neck can be surgically salvaged more than 50% of the time.
Objective To understand the effects of positron emission tomography/computed tomography (PET/CT) evaluation on patients with previously untreated head and neck squamous cell carcinoma (HNSCC) with clinical evidence of regional lymph node involvement. Study Design Prospective blinded study. Setting Tertiary care cancer center. Subjects and Methods Informed consent was obtained and data collected from 52 consecutive previously untreated patients with HNSCC and clinical evidence of cervical metastasis. All patients underwent conventional evaluation for HNSCC and whole body PET/CT. Data were evaluated by 5 independent reviewers, who performed TNM staging per the American Joint Committee on Cancer (seventh edition) manual and proposed a treatment plan prior to viewing, and after reviewing, PET/CT. Cases where at least 3 of 5 reviewers agreed were considered significant. Results There were 0 patients for whom review of the PET/CT altered the T-class assessment (95% CI, 0-6.8), 12 (23.1%) for whom PET/CT altered N classification (95% CI, 12.5-34.5), and 2 (3.8%) for whom PET/CT altered the M classification (95% CI, 0.5-13.2). For 5 patients (9.6%), overall stage was altered per PET/CT review (95% CI, 3.2-21). For 3 patients (5.8%), PET/CT findings prompted reviewers to alter treatment recommendations (95% CI, 1.2-15.9). Conclusion When added to more conventional patient evaluation, PET/CT results in changes to the TNM categories, but overall staging and treatment were less frequently affected. Whether PET/CT should be used routinely for patients with stage III and IV HNSCC is still subjective and merits further study.
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