The role of elective nodal irradiation for esthesioneuroblastoma patients with clinically negative neck

Abstract

Purpose 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 radiotherapy as a component of multi-modality treatment. Methods and Materials Seventy-one N0 ENB patients irradiated at XXXXXXXXX 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 month). 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-year (regional control rate of 100% for ENI vs 82%, p < 0.001), 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 month. Conclusion 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.

Volumetric analysis of olfactory neuroblastoma skull base laterality and implications on neck disease

“…Although these data emphasize the necessity of bilateral treatment when considering elective neck therapy, much controversy exists surrounding the efficacy of elective neck irradiation or dissection in managing patients with ONB . The most compelling evidence against elective neck therapy stems from the apparent lack of improved survival outcomes in patients who undergo elective neck irradiation, despite achieving excellent regional control . The present study demonstrates 100% regional control after elective neck irradiation, which agrees with previous studies; but these data are too underpowered to draw survival or disease‐control conclusions.…”

“…Researchers have speculated that the midline nature of ONBs and observed bilateral nodal involvement likely warrant bilateral nodal therapy of the neck, particularly when considering elective neck treatment . In contrast, other research has justified the use of unilateral elective neck irradiation based on tumor laterality . Data obtained from our analysis on ONB sidedness showed that the nodal spread patterns predominantly were bilateral irrespective of the degree of laterality of the tumor.…”

“…Ten‐year disease‐specific survival drops from 90% to 36% for patients with cervical lymph node metastasis compared to patients with disease limited to the nasal cavity . Because of these prognostic consequences, studies have investigated the role of elective neck treatment in the clinically negative neck . However, despite the critical implications of neck disease in ONB, relatively few studies have reported the patterns of nodal spread.…”

“…Emerging research addressing this question observes level II lymph nodes to be the most frequently involved, followed by levels I and III. Retropharyngeal lymph node involvement has been described, although its frequency is inconsistently demonstrated …”

Assessment of frozen section margin analysis during olfactory neuroblastoma surgery

“…This neoplasm is locally aggressive and commonly involves the nasal cavity, paranasal sinuses, and cribriform plate; there also may be extension into the cranial and orbital compartments. Many patients develop neck and distant metastasis during the course of their disease …”