Long-term analysis of multimodality treatment outcomes and prognosis of esthesioneuroblastomas: a single center results of 138 patients

Abstract

Background The aim of this study is to evaluate the efficacy of different treatment strategies and the potential prognostic factors of esthesioneuroblastoma (ENB). Materials and methods Between April 1984 and December 2018, 138 patients with non-metastatic ENB were retrospectively analyzed. The treatment modalities mainly included surgery alone (n = 7), radiotherapy alone (n = 33), concurrent chemoradiotherapy (n = 17), surgery combined with current chemoradiotherapy (n = 32), and surgery plus radiotherapy (n = 49). Results The median follow-up time for the entire cohort was 61 months (range, 4–231 months). The 5-year overall survival (OS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS) rate were 69.6, 78.0 and 73.9%, respectively. Surgery combined with radiotherapy elicited superior survival results, and the combination of surgery and current chemoradiotherapy achieved the best prognoses for all patients, patients with advanced Kadish disease, patients receiving intensity modulated radiation therapy and those with positive surgical margin. Univariate analysis identified orbital invasion and treatment modalities were predictors for OS, LRFFS and DMFS. Lymph node metastasis was associated with OS and DMFS, but not LRFFS. Intracranial invasion, advanced Kadish stage and not receiving concurrent chemotherapy were also predictive of lower OS. Multivariate analyses indicated that lymph node metastasis was an independent prognostic factor affecting DMFS, whereas treatment modalities was independent prognostic factors for OS and LRFFS. Conclusion Orbital invasion, intracranial invasion, lymph node metastasis and advanced Kadish disease at initial diagnosis were significantly associated with inferior prognosis. Regarding the treatment modality, the optimal strategy remined surgery with radiotherapy-based multimodality treatment. The concurrent chemoradiotherapy may play a more beneficial role.

Long‐term oncologic outcomes in esthesioneuroblastoma: An institutional experience of 143 patients

“…The rate of regional disease at presentation in our study was 13.8%. This supports previous studies that have demonstrated rates of cervical lymph node involvement in up to 25% and that this is associated with worsening survival outcomes 27 . These findings support the addition of mKadish stage D by Morita et al 20 as both metastasis to cervical lymph nodes or distant metastasis were found to be associated with worsening OS in our study.…”

“…This supports previous studies that have demonstrated rates of cervical lymph node involvement in up to 25% and that this is associated with worsening survival outcomes. 27 These findings support the addition of mKadish stage D by Morita et al 20 as both metastasis to cervical lymph nodes or distant metastasis were found to be associated with worsening OS in our study. However, a study utilizing the National Cancer Database has demonstrated that patients who have mKadish stage D with cervical lymph node involvement have different survival outcomes than those with distant metastasis; therefore, they propose a revision to the Kadish staging system that would separate these two types of metastases.…”

“…This strengthens previous large database studies reported by Tajudeen et al and Zeng et al that have demonstrated a negative prognostic value of high Hyams grade on oncologic outcomes 9,18,25 . Additionally, Sun et al, Song et al, Van Gompel et al, and Tajudeen et al demonstrated a negative prognostic value of high mKadish stage on oncologic outcomes 9,18,25,27 . This is in contrast to a study of 124 patients by Bell et al that did not demonstrate a relationship between mKadish stage and OS, but higher Hyams grade was associated with worsened DFS 28 .…”

Olfactory Neuroblastomas: What Actually Happens in the Long-Term?

“…Secondly, it gives computer tomography, MRI, or FDG-PET/CT the lead over ultrasound in the imaging of the neck. Considering the fact that an N+ situation changes the stage to Kadish-Morita D [26], worsens the prognosis [12,35], and definitively justifies adjuvant irradiation in the initial phase [42], it cannot be emphasized enough that a thorough initial scan of the patient is of major importance. A reasonable treatment algorithm should be based on thorough knowledge of the biologic (metastatic) behavior of the disease.…”

Neuroblastoma olfatorio. Reporte de caso

“…Para el manejo de esta enfermedad se han empleado múltiples estrategias, desde cirugía exclusiva, asociaciones de radioterapia y quimioterapia, cirugía y radioterapia hasta la asociación de las tres armas terapéuticas: cirugía, radioterapia y quimioterapia [9][10][11][12][13][14] .…”