J Korean Soc Ther Radiol Oncol.  2009 Dec;27(4):189-193. 10.3857/jkstro.2009.27.4.189.

Treatment and Prognosis for an Esthesioneuroblastoma over a 20-Year Period: Impact of Treatment Era

• Song CH
• Kim IH
• Wu HG
• Kim DW
• Rhee CS

• KMID: 2003431
• DOI: http://doi.org/10.3857/jkstro.2009.27.4.189

Abstract

PURPOSE
To report on the changes in the patterns of care and survival over time for esthesioneuroblastoma. MATERIALS AND METHODS: We retrospectively analyzed 42 previously untreated and histologically confirmed esthesioneuroblastoma patients seen between March 1989 and June 2007. According to Kadish's classification, 3 patients (7%) were stage A, 6 (14%) at stage B, and 33 (79%) at stage C. Of the 33 Kadish C patients, 19 and 14 patients were treated from 1989 through 2000 and from 2001 through 2007, respectively. Treatment included surgical resection, radiotherapy, chemotherapy, or a combination of these methods. Chemotherapy was administered to 8 of 19 patients (42%) seen from 1989 through 2000, whereas all of the 14 patients seen from 2001 through 2007 received chemotherapy (p<0.001). No patient was treated by three-dimensional conformal radiotherapy (3D-CRT) from 1989 through 2000, however 8 of 14 patients (67%) seen from 2001 through 2007 underwent 3D-CRT (p<0.001). The median follow-up time for surviving patients was 6.5 years (range, 2.2~15.8 years). RESULTS: The 5-year overall survival (OS) and progression-free survival (PFS) rates for the entire cohort were 53% and 39%, respectively. The 5-year OS was 100% for Kadish stages A or B and 39% for stage C (p=0.007). For patients with stage C disease who were treated from 1989 to 2000 and from 2001 to 2007, the 5-year OS rate was 26% and 59% (p=0.029), respectively and the corresponding 5-year PFS rate was 16% and 46% (p=0.001), respectively. Intraorbital extension and treatment era (1989~2000 vs. 2001~2007) were found as independent factors for OS and PFS in a multivariate analyses. CONCLUSION: The results of this study suggest that treatment era, which features a distinction in treatment modality and technique with the introduction of 3D-CRT, may be the cause of improved OS and PFS in Kadish stage C patients. To achieve better outcomes for patients with Kadish stage C, combined chemoradiotherapy, especially 3D-CRT, is recommended in addition to surgery.

Keyword

Esthesioneuroblastoma; Olfactory neuroblastoma; Radiotherapy; Chemotherapy

MeSH Terms

Chemoradiotherapy
Cohort Studies
Disease-Free Survival
Esthesioneuroblastoma, Olfactory
Follow-Up Studies
Humans
Multivariate Analysis
Prognosis
Radiotherapy, Conformal
Retrospective Studies