1
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Magnetic resonance imaging findings in patients with idiopathic olfactory dysfunction and normal findings on nasoendoscopy. J Laryngol Otol 2023; 137:85-88. [PMID: 35445651 PMCID: PMC9834702 DOI: 10.1017/s0022215122000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE In presentations of anosmia or dysosmia, magnetic resonance imaging may be required to screen for intracranial pathology such as olfactory neuroblastomas and other intracranial masses impacting on the olfactory pathway. This study aimed to establish positive magnetic resonance imaging findings of anosmia or dysosmia for scans performed before the coronavirus disease 2019 pandemic. METHODS The study examined the outcome of patients who presented with isolated olfactory dysfunction and who underwent magnetic resonance imaging between 2015 and 2019. RESULTS Of the 131 patients, 41 (31.3 per cent) had normal scan findings, 50 (38.2 per cent) had insignificant paranasal mucosal disease and 6 (4.6 per cent) had mucosal thickening significant enough to require additional intervention. These interventions included repeat nasoendoscopy or commencement of intranasal or oral steroids. No patients had olfactory neuroblastoma. CONCLUSION Only 4.6 per cent of the magnetic resonance imaging scans revealed abnormal findings related to anosmia or dysosmia, and none required ENT surgical intervention. None of the magnetic resonance imaging scans identified an olfactory neuroblastoma or intracranial masses impacting on the olfactory pathway.
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2
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Mantsopoulos K, Koch M, Iro H, Constantinidis J. Olfactory Neuroblastomas: What Actually Happens in the Long-Term? J Clin Med 2022; 11:jcm11092288. [PMID: 35566413 PMCID: PMC9105484 DOI: 10.3390/jcm11092288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
Objective: The aim of this study was to investigate the long-term oncologic outcome and review the state of the art in the management of olfactory neuroblastomas. Material and Methods: The records of all patients treated for olfactory neuroblastomas in two academic departments between 1975 and 2012 were evaluated retrospectively. Data on epidemiological parameters were collected (age, gender), along with staging (Kadish, Morita), histologic grading (Hyams), time and form of treatment, locoregional control, and disease-specific and overall survival. Patients with other malignant diseases, distant metastases of olfactory neuroblastomas at the time of initial diagnosis, a follow-up time of less than 5 years, or insufficient clinical-pathological data were excluded from further analysis. Results: In total, 53 cases made up our final study sample (26 men, 27 women; male–female ratio 0.96:1). Their mean age was 48.6 years (range: 10–84 years). The mean follow-up time was 137.5 months (4–336 months, SD: 85.0). A total of 5 out of 53 study cases (9.4%) showed metastatic involvement of the neck at the time of initial presentation. Local recurrence was detected in 8/53 (15.1%) and regional recurrence in 7/53 of our study cases (13.2%). Three patients (42.8%) from the group of cases with surgery as the sole form of management (7/53, 13.2%) died due to the disease. The cumulative disease-specific survival and overall survivalfor the whole group of patients were 88.6% and 63.6%, respectively. The cumulative disease-specific survival stratified by Kadish A/B vs. Kadish C/D as well as Hyams I/II vs. Hyams III/IV showed superior results for limited tumors, albeit without significance, and low-grade tumors (highly significant difference). Conclusion: Craniofacial or sometimes solely endoscopically controlled resection can warrant resection of the olfactory neuroblastoma with wide margins. However, locoregional failures and distant metastases can occur after a long period of time. The non-negligible incidence of regional recurrences, partly in unusual localizations, leads us to consider the need to identify the “recurrence-friendly” cases and to perform individualized elective irradiation of the neck in cases with high-risk features.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen–Nürnberg, 91054 Erlangen, Germany; (M.K.); (H.I.)
- Correspondence: ; Tel.: +49-(0)9131-8533156; Fax: +49-(0)9131-8533833
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen–Nürnberg, 91054 Erlangen, Germany; (M.K.); (H.I.)
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen–Nürnberg, 91054 Erlangen, Germany; (M.K.); (H.I.)
| | - Jannis Constantinidis
- 1st Department of Otolaryngology, Head & Neck Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
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Spielman DB, Liebowitz A, Grewal M, Safi C, Overdevest JB, Iloreta AM, Youngerman BE, Gudis DA. Exclusively endoscopic surgical resection of esthesioneuroblastoma: A systematic review. World J Otorhinolaryngol Head Neck Surg 2022; 8:66-72. [PMID: 35619935 PMCID: PMC9126163 DOI: 10.1002/wjo2.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection. Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach, however, the rarity of this disease limits the availability of long‐term and large scale outcomes data. Objective The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery. Methods In accordance with PRISMA guidelines, PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas. Results Forty‐four out of 2462 articles met inclusion criteria, totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach. Seventy‐two patients (18.0%) received adjuvant chemotherapy and 331 patients (83.0%) received postoperative radiation therapy. The average age was 50.6 years old (range 6–83). Of the 399 patients, 57 (16.6%) were Kadish stage A, 121 (35.2%) were Kadish stage B, 145 (42.2%) were Kadish stage C, and 21 (6.1%) were Kadish stage D. Pooled analysis demonstrated that 66.0% of patients had Hyams histologic Grade Ⅰ or Ⅱ, while 34.0% of patients had Grade Ⅲ or Ⅳ disease. Negative surgical margins were achieved in 86.9% of patients, and recurrence was identified in 10.3% of patients. Of those with 5‐year follow‐up, reported overall survival was 91.1%. Conclusion Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades, and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy. Reported overall recurrence rate is 10.3% and 5‐year survival is 91.1%.
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Affiliation(s)
- Daniel B. Spielman
- Department of Otolaryngology‐Head and Neck Surgery New York‐Presbyterian Hospital—Columbia University Irving Medical Center New York New York USA
| | - Andi Liebowitz
- Department of Otolaryngology‐Head and Neck Surgery New York‐Presbyterian Hospital—Columbia University Irving Medical Center New York New York USA
| | - Maeher Grewal
- Department of Otolaryngology‐Head and Neck Surgery New York‐Presbyterian Hospital—Columbia University Irving Medical Center New York New York USA
| | - Chetan Safi
- Department of Otolaryngology‐Head and Neck Surgery New York‐Presbyterian Hospital—Columbia University Irving Medical Center New York New York USA
| | - Jonathan B. Overdevest
- Department of Otolaryngology‐Head and Neck Surgery New York‐Presbyterian Hospital—Columbia University Irving Medical Center New York New York USA
| | - Alfred M. Iloreta
- Department of Otolaryngology‐Head and Neck Surgery The Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai New York New York USA
| | - Brett E. Youngerman
- Department of Neurological Surgery New York‐Presbyterian Hospital—Columbia University Irving Medical Center New York New York USA
| | - David A. Gudis
- Department of Otolaryngology‐Head and Neck Surgery New York‐Presbyterian Hospital—Columbia University Irving Medical Center New York New York USA
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4
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Jiang S, Fan R, Zhang H, Jiang W, Xie Z. Outcomes of endoscopic and open resection of sinonasal malignancies: a systematic review and meta-analysis. Braz J Otorhinolaryngol 2021; 88 Suppl 5:S19-S31. [PMID: 34348855 PMCID: PMC9800954 DOI: 10.1016/j.bjorl.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To compare the efficacy of endoscopic and open resection of sinonasal malignancies. METHODS The search was performed using PubMed (1950-2020), Embase (1974-2020), the Cochrane library, and the website clinicaltrials.gov. The hazard ratio, HR, 95% confidence interval, CI, of the rates of overall survival and disease-free survival and the demographic characteristics of the included studies were extracted and analyzed. Pooled analysis was conducted with the studies' individual patient data, using log-rank test, Kaplan-Meier survival, and Cox regression analysis. RESULTS Of 1939 articles retrieved, 23 articles were included. Overall, 1373 cases were incorporated into the final analysis, 653 (47.56%) of which underwent the surgery through an endoscopic approach, whereas 720 (52.44%) cases utilized the open approach. The overall survival was comparable between endoscopic and open resection (HR = 0.84 [95% CI: 0.65-1.07], p = 0.16; random effects analysis). Pooled analysis with Cox regression revealed signifcant differences in overall survival (HR = 0.568 [95%CI:0.380-0.849], p = 0.006) and disease-free survival (HR = 0.628 [95%CI:0.424-0.929], p = 0.02) between endoscopic and open approaches. CONCLUSION The aggregated evidence suggests the survival outcome of endoscopic resection is comparable or greater than that of open resection of sinonasal malignancies.
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5
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Consolidating the Hyams grading system in esthesioneuroblastoma - an individual participant data meta-analysis. J Neurooncol 2021; 153:15-22. [PMID: 33770323 DOI: 10.1007/s11060-021-03746-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Esthesioneuroblastoma (ENB) is an uncommon primary sinonasal tumor which can extend intracranially. Exactly how to classify them pathologically still remains discrepant; the Hyams grading system, for example, has not been universally adopted. This individual patient data (IPD) meta-analysis aimed to investigate the prognostic implication of each Hyams grade on patient outcomes. METHODS We accessed two electronic databases including PubMed and Web of Science. Raw patient data from potential articles were extracted. To examine the associations of various clinicopathological factors with the Hyams grades, we utilized Chi-square, t-test, and Mann-Whitney, as appropriate. Log-rank test and Cox regression analysis were used to elucidate the impact of the Hyams grades on recurrence-free survival (RFS), metastasis-free survival (MFS), and overall survival (OS) of ENB patients. RESULTS We included 33 studies with 492 ENB patients. We found significant associations of Kadish stages, Dulguerov stages, rates of recurrence, metastasis, and patient mortality with Hyams grade. Log-rank tests and Cox regression models demonstrated significant differences in RFS and OS of Hyams grade I - II, grade III, and grade IV patients. There was no statistical difference in RFS and OS of Hyams grade I and II. Radiotherapy was only effective in grade III - IV ENBs and chemotherapy showed no benefits to patients. CONCLUSION We verify that the Hyams grading system appears to be a reliable prognostic indicator to assess ENB patient outcomes. Consolidating the Hyams grading system into a three-tier system based on similar clinical outcomes of grades I and II may simplify this classification schema.
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6
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Meerwein CM, Nikolaou G, H A Binz G, Soyka MB, Holzmann D. Surgery as Single-Modality Treatment for Early-Stage Olfactory Neuroblastoma: An Institutional Experience, Systematic Review and Meta-analysis. Am J Rhinol Allergy 2020; 35:525-534. [PMID: 33174762 DOI: 10.1177/1945892420973163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND For olfactory neuroblastoma (ONB), the combination of surgical tumor resection and radiation therapy (RT) has been considered the "gold standard" in treatment protocols intended to cure. OBJECTIVE To summarize evidence on the treatment of ONB using surgery alone. METHODS A retrospective institutional case series, a systematic review of the literature, and an individual patient data (IPD) meta-analysis on only surgically treated ONB patients. RESULTS At our institution, a total of 10 patients were treated through surgery alone and remained alive and free of disease at last follow-up. The IPD meta-analysis on 128 patients revealed a disease-free survival (DFS) and overall survival (OS) of 67.7% and 75.4% at 5 years and 57.1% and 71.9% at 10 years, respectively. Univariate analysis showed that Kadish stage C/D and Hyams grading III//IV significantly affected OS (P = 0.000 and P = 0.000) and DFS (P = 0.000 and P = 0.002). For low-risk patients, the DFS was 80.6% at 5 years and 67.8% at 10 years, respectively. CONCLUSIONS Surgery alone is an equivalent alternative to combined treatment in carefully selected low-risk ONB patients with better outcome measures than previously reported.
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Affiliation(s)
- Christian M Meerwein
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Georgios Nikolaou
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Gregori H A Binz
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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7
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Kiyofuji S, Agarwal V, Hughes JD, Foote RL, Janus JR, Moore EJ, Giannini C, Link MJ, Van Gompel JJ. Delaying Postoperative Radiotherapy in Low-Grade Esthesioneuroblastoma: Is It Worth the Wait? J Neurol Surg B Skull Base 2020; 82:e166-e171. [PMID: 34306932 DOI: 10.1055/s-0040-1708854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
Abstract
Background Consensus in timing of radiotherapy is yet to be established in esthesioneuroblastoma (ENB). Objective This study was aimed to investigate if planned adjuvant radiotherapy improves tumor control after complete margin negative resection of low Hyams' grade (1 or 2) ENB. Methods A retrospective review of patients with pathologically confirmed negative margin resection of Kadish's stage B or C and Hyams' grade 1 and 2 ENBs was conducted. Seventeen patients meeting the criteria were divided into the following two groups for cohort study: (1) those who underwent planned immediate postoperative adjuvant radiotherapy (IR group) and (2) those who did not (delayed radiotherapy [DR] group). Results The IR group included nine patients (Kadish's stage B in one and stage C in eight; Hyams' grade 1 in two and grade 2 in seven). Mean follow-up was 140.8 months. Seven patients (78%) had disease progression (DP) at a median of 88 months (four with cervical lymph node metastasis [CLNM], one with distant metastasis, and two with both local recurrence and CLNM). One patient experienced frontal lobe abscess. The DR group included eight patients (Kadish's stage B in six and stage C in two; all Hyams' grade 2). Mean follow-up was 123.3 months. Four (50%) patients who developed DP (all local recurrence) were salvaged with surgery and adjuvant radiotherapy at a median of 37.5 months. There was no statistically significant difference in DP rate ( p = 0.23), time to DP ( p = 0.26), or the local tumor control rate ( p = 0.23). Conclusion In our limited cohort, immediate postoperative radiotherapy did not demonstrate superiority in tumor control, although risk of radiotherapy toxicity appears low.
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Affiliation(s)
- Satoshi Kiyofuji
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
| | - Vijay Agarwal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Joshua D Hughes
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jeffrey R Janus
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Caterina Giannini
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
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8
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Goshtasbi K, Abiri A, Abouzari M, Sahyouni R, Wang BY, Tajudeen BA, Hsu FPK, Cadena G, Kuan EC. Hyams grading as a predictor of metastasis and overall survival in esthesioneuroblastoma: a meta-analysis. Int Forum Allergy Rhinol 2019; 9:1054-1062. [PMID: 31251848 DOI: 10.1002/alr.22373] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, represents up to 3% of all sinonasal neoplasms. Hyams histologic grading is a promising tool in predicting metastases and establishing prognoses for this complex tumor. METHODS A systematic literature search was performed in the PubMed, Ovid MEDLINE, and Cochrane databases. ENB patients with Hyams I-II or III-IV were categorized as low-grade Hyams (LGH) or high-grade Hyams (HGH), respectively. Binary and continuous random-effects models were applied to calculate odds ratios (ORs) for the incidences of neck and distal metastases as well as for 5- and 10-year overall survival rates. RESULTS Of the 57 screened articles published from 1993 to 2018, 16 (525 patients) and 21 (563 patients) provided data for tumor metastases and overall survival rates, respectively. Neck metastasis was observed in 18.2% of HGH vs 7.9% of LGH patients. Distant metastasis was noted in 20.7% of HGH vs 8.9% of LGH patients. LGH patients had 5- and 10-year overall survival rates of 81.2% and 64.0%, respectively, as compared with 60.9% and 40.6%, respectively, for HGH patients. In comparing HGHs vs LGHs, the collective ORs for neck and distant metastases were 2.08 (95% confidence interval [CI], 1.09-3.99; p = 0.03) and 2.37 (95% CI, 1.07-5.26; p = 0.03), respectively. Moreover, in comparing LGHs vs HGHs, collective ORs for 5- and 10-year overall survival rates were 3.39 (95% CI, 2.09-5.49; p < 0.001) and 3.03 (95% CI, 1.82-5.06; p < 0.001), respectively. CONCLUSION HGH ENBs, compared with LGH ENBs, are more likely to metastasize to neck or distal targets and to have lower overall survival rates.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
| | - Ronald Sahyouni
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
| | - Beverly Y Wang
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA
| | - Bobby A Tajudeen
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, CA
| | - Gilbert Cadena
- Department of Neurological Surgery, University of California, Irvine, CA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA
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9
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Peng X, Liu Y, Peng X, Wang Z, Zhang Z, Qiu Y, Jin M, Wang R, Kong D. Clinical features and the molecular biomarkers of olfactory neuroblastoma. Pathol Res Pract 2018; 214:1123-1129. [PMID: 29921494 DOI: 10.1016/j.prp.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 01/07/2023]
Abstract
Olfactory neuroblastoma (ONB) is a kind of rare and complex head and neck tumor. The reports on this field are very scarce due to the low morbidity. Here, we summarized the clinical features and prognosis of ONB through analysis of 10 cases, and determined the phosphorylation status of some molecules known to be involved in carcinogesis such as Akt, Erk, Stat3 and Stat5 in ONB tissue. Ten ONB patients were recruited in this study, 6 male and 4 female, ranging from 26 to 66 years old. In the 10 cases, 6 were diagnosed as late T stage (T3/T4), 6 were at late Kadish stage (C/D) and 3 were at high Hyams grade (Ⅲ), which indicated a poorer prognosis. Patient characteristics-gender and tumor features were evaluated with respect to the overall survival (OS) through univariate analysis. The result indicated that the OS of male is obviously higher than that of female after a series of combined treatment. The OS of ONB patients in the late stage or high grade is lower than those in early stages or low grade. Moreover, p-Akt, p-Erk, p-Stat3 and p-Stat5 was detected in 5 (50%), 9 (90%), 7 (70%) and 0 patients (0%), respectively, suggesting the former 3 molecules might be potential biomarkers for diagnosis of ONB.
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Affiliation(s)
- Xiaolin Peng
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China; Department of Otorhinolaryngology Head and Neck Surgery, Tianjin first central hospital, Tianjin 300192, China
| | - Yao Liu
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China
| | - Xin Peng
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China
| | - Zhengming Wang
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China
| | - Zhe Zhang
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China
| | - Yuling Qiu
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China
| | - Meihua Jin
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China
| | - Ran Wang
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China.
| | - Dexin Kong
- Tianjin Key Laboratory on Technologies Enabling Development of Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin 300070, China; Research Center of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China.
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10
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Marinelli JP, Janus JR, Van Gompel JJ, Link MJ, Foote RL, Lohse CM, Price KA, Chintakuntlawar AV. Esthesioneuroblastoma with distant metastases: Systematic review & meta-analysis. Head Neck 2018; 40:2295-2303. [PMID: 29756250 DOI: 10.1002/hed.25209] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/29/2018] [Accepted: 03/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the clinical outcomes and review the management strategies for metastatic esthesioneuroblastoma. METHODS We conducted a systematic review and meta-analysis. RESULTS Forty-eight studies totaling 118 patients met inclusion criteria. Chemotherapy in combination with surgery and/or radiation exhibited the best overall survival when compared to monotherapy and no treatment (P < .001). However, most patients (66%) received either monotherapy or no therapy. The number and location of metastases among the 3 treatment groups did not significantly differ (P = .85). Treatment modality remained significantly associated with overall survival on multivariable analysis (P < .001). Platinum-based chemotherapy was most commonly utilized but did not provide a survival benefit when compared with all other regimens (P = .88). CONCLUSION Distant metastases with esthesioneuroblastoma portend a poor prognosis. Chemotherapy in combination with surgery and/or radiation was associated with improved overall survival. Further research into the optimal systemic therapeutic regimen for patients with distant metastases is critical.
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Affiliation(s)
- John P Marinelli
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jamie J Van Gompel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Link
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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11
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Harvey RJ, Nalavenkata S, Sacks R, Adappa ND, Palmer JN, Purkey MT, Schlosser RJ, Snyderman C, Wang EW, Woodworth BA, Smee R, Havas T, Gallagher R. Survival outcomes for stage-matched endoscopic and open resection of olfactory neuroblastoma. Head Neck 2017; 39:2425-2432. [PMID: 28945299 DOI: 10.1002/hed.24912] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 03/28/2017] [Accepted: 07/11/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Advanced-stage olfactory neuroblastoma requires multimodal therapy for optimal outcomes. Debate exists over endoscopic endonasal surgery in this situation. Stage-matched open and endoscopic surgical therapy were compared. METHODS Patients from 6 cancer institutions were assessed. Stratification included dural involvement, Kadish stage, nodal disease, Hyams' grade, approach, and margin status. At follow-up, local control, nodal status, and evidence of distant metastases were recorded with any subsequent therapy. Statistical analyses to identify risk factors for developing recurrence and survival differences were performed. RESULTS One hundred nine patients were assessed (age 49.2 ± 13.0 years; 46% women) representing Kadish A stage (10%), Kadish B stage (25%), and Kadish C stage (65%). The majority of the patients (61.5%) underwent endoscopic resection, 53.5% within Kadish C stage. Within-stage survival analysis favored endoscopic subgroup for Kadish C stage (log-rank P = .017) nonsignificant for Kadish B stage (log-rank P = .39). CONCLUSION Stage-matched survival was better for the endoscopically treated group compared to the open surgery group, with high negative margin resections obtained.
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Affiliation(s)
- Richard J Harvey
- Applied Medical Research Centre, University of New South Wales, Kensington, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.,Department of Otolaryngology - Head and Neck, Skull Base Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Sunny Nalavenkata
- Applied Medical Research Centre, University of New South Wales, Kensington, Australia
| | - Raymond Sacks
- Applied Medical Research Centre, University of New South Wales, Kensington, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia.,Department of Otolaryngology, Concord General Hospital and Sydney University, Concord, New South Wales, Australia
| | - Nithin D Adappa
- Department of Otorhinolaryngology/ Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James N Palmer
- Department of Otorhinolaryngology/ Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael T Purkey
- Department of Otorhinolaryngology/ Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rodney J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Carl Snyderman
- Department of Otolaryngology/ Head & Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Eric W Wang
- Department of Otolaryngology/ Head & Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bradford A Woodworth
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Prince of Wales, Australia
| | - Tom Havas
- Department of Otolaryngology, Head and Neck Surgery, The Prince of Wales Cancer Centre and Hospital, Prince of Wales, Australia
| | - Richard Gallagher
- Department of Otolaryngology - Head and Neck, Skull Base Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
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12
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Wertz A, Hollon T, Marentette LJ, Sullivan SE, McHugh JB, McKean EL. Surgical Treatment of Olfactory Neuroblastoma: Major Complication Rates, Progression Free and Overall Survival. J Neurol Surg B Skull Base 2017; 79:151-155. [PMID: 29868319 DOI: 10.1055/s-0037-1605593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 06/21/2017] [Indexed: 10/19/2022] Open
Abstract
Objective We aimed to compare major complication rates in patients undergoing open versus endoscopic resection of olfactory neuroblastoma (ONB) and to determine the prognostic utility of the Kadish staging and Hyams grading systems with respect to progression-free survival (PFS) and overall survival (OS). Methods It is a retrospective review of experience in treating ONB at a single tertiary care hospital from 1987 through 2015. Major complications were defined as cerebrospinal fluid (CSF) leak, meningitis, osteomyelitis, tracheostomy, and severe neurologic injury. Results Forty-one patients were included. An open approach was used in 34 (83%), endoscopic in 6 (15%), and combined in 1 (2%) case. Rates of major complications by surgical approach were 17% after endoscopic versus 31% after open ( p = 0.65). There was no significant difference in PFS or OS based on Kadish B versus C (PFS, p = 0.28; OS, p = 0.11) or Hyams grade 1 and 2 versus Hyams grade 3 and 4 (PFS, p = 0.53; OS, p = 0.38). Conclusions There was no significant difference in major complications between open and endoscopic approaches for the treatment of ONB. Patient stratification using the Kadish staging and Hyams grading systems did not show significant differences in PFS or OS. Further research is needed to determine if a different staging system would better predict patient outcomes.
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Affiliation(s)
- Aileen Wertz
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Todd Hollon
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Lawrence J Marentette
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States.,Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Stephen E Sullivan
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Erin L McKean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, United States.,Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, United States
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Hwang CS, Seo YW, Park SC, Chung HJ, Cho HJ, Yoon JH, Kim CH. Role of surgical treatment for esthesioneuroblastomas: 31-Year experience at a single institution. J Craniomaxillofac Surg 2016; 45:120-126. [PMID: 27840119 DOI: 10.1016/j.jcms.2016.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/31/2016] [Accepted: 10/10/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study aimed to re-assess the outcomes of different surgical methods for esthesioneuroblastoma (ENB) in a single institution, with emphasis on changes in surgical treatment with regard to endoscopic approaches in patients with ENB. SUBJECTS AND METHODS We retrospectively reviewed the data of 35 patients with ENB treated over the last 31 years. RESULTS The 5-year overall and disease-free survival rates were 66.8% and 50.8%, respectively. Disease-free survival in the endoscopic surgery group was significantly higher compared to that of craniofacial surgery group (P = 0.035). In the endoscopic surgery group, nine of 10 patients did not exhibit local failure or regional recurrence over a mean followup period of 64.3 months, which was longer than the mean time to recurrence (22.0 months) observed in this study. CONCLUSION Given its significant survival outcomes and high rate of local control, endoscopic surgery could be preferred as a minimally invasive treatment with potentially low morbidity and possible oncological validity for the treatment of ENB.
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Affiliation(s)
- Chi Sang Hwang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Wook Seo
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Chul Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Jin Chung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea; The Airway Mucus Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea.
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Rawal RB, Farzal Z, Federspiel JJ, Sreenath SB, Thorp BD, Zanation AM. Endoscopic Resection of Sinonasal Malignancy. Otolaryngol Head Neck Surg 2016; 155:376-86. [DOI: 10.1177/0194599816646968] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 04/08/2016] [Indexed: 01/23/2023]
Abstract
Objectives The use of endoscopic approaches for sinonasal malignancy resection has increased, but survival data are limited secondary to disease rarity and new surgical technique. Here we present a systematic review and meta-analysis of endoscopic endonasal resection of sinonasal malignancy. Data Sources MEDLINE, PubMed Central, NCBI Bookshelf, Cochrane Library, clinicaltrials.gov, National Guideline Clearinghouse. Review Methods PRISMA/MOOSE guidelines were followed. MeSH terms were “endoscopic” AND (“esthesioneuroblastoma” OR “sinonasal adenocarcinoma” OR “squamous cell carcinoma” OR “sinonasal undifferentiated carcinoma”). For studies in which individual-level data were available, results were obtained by direct pooling. For studies in which only summary Kaplan-Meier curves were available, numerical data were extracted, traced, and aggregated by fitting a Weibull model. Results Of 320 studies identified, 35 case series were included (n = 952 patients), with 15 studies analyzed via aggregate modeling and 20 studies analyzed via direct pooling. Two- and 5-year survival rates for patients in aggregate modeling were 87.5% and 72.3%, respectively (mean follow-up: 32.9 months). Two- and 5-year survival for patients in direct pooling were 85.8% and 83.5%, respectively (mean follow-up: 43.0 ± 19.5 months). Significant overall survival difference was found between low- and high-grade cancers ( P = .015) but not between low- and high-stage cancers ( P = .79). Conclusion Overall 2- and 5-year survival rates are comparable and sometimes greater than those from open craniofacial resection. Survival rates significantly differ by cancer grade but not stage. Journals and investigators should be encouraged to publish retrospective and prospective case series with staged survival updates based on established guidelines.
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Affiliation(s)
- Rounak B. Rawal
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zainab Farzal
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jerome J. Federspiel
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Satyan B. Sreenath
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian D. Thorp
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam M. Zanation
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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McLean JN, Nunley SR, Klass C, Moore C, Müller S, Johnstone PAS. Combined modality therapy of esthesioneuroblastoma. Otolaryngol Head Neck Surg 2016; 136:998-1002. [PMID: 17547995 DOI: 10.1016/j.otohns.2006.11.051] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 11/30/2006] [Indexed: 10/23/2022]
Abstract
Objective Esthesioneuroblastoma (ENB) is a rare tumor of the olfactory epithelium. The objective of this study was to evaluate treatment modalities including surgery, IMRT, and chemotherapy and patient outcomes. Patients and Methods A retrospective analysis was performed on a total of 21 patients. Therapy included craniofacial resection (CFR), radiotherapy, chemotherapy, or a combination of these methods. Results The median follow-up period was 47 months. Surgery was performed in 90.4% of cases; radiotherapy was performed adjuvantly in 15 (72.7%) patients. Surgery, radiotherapy, and chemotherapy were administered to 7 (33.3%) patients. Eight (38.3%) patients had local recurrence. The 5-year crude overall survival was 71.4% and actuarial 5-year overall survival was 58% with confidence interval (CI, 25 and 81, respectively). The 5-year crude disease-free survival rate was 59% and the 5-year actuarial disease-free survival rate was 62% (CI, 28 and 83, respectively). Conclusion Multidisciplinary therapy of ENB should be considered, especially for Kadish C and high-grade lesions. Craniofacial resection (CFR), Intensity modulated radiation therapy (IMRT), and chemotherapy should be investigated in a multi-institution trial of ENB. © 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Affiliation(s)
- J Nicolas McLean
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA
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Naples JG, Spiro J, Tessema B, Kuwada C, Kuo CL, Brown SM. Neck recurrence and mortality in esthesioneuroblastoma: Implications for management of the N0 neck. Laryngoscope 2015; 126:1373-9. [PMID: 26607219 DOI: 10.1002/lary.25803] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/11/2015] [Accepted: 10/30/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To review the literature on neck recurrence in esthesioneuroblastoma. STUDY DESIGN PubMed database. METHODS A PubMed database search was performed using keywords "esthesioneuroblastoma," "olfactory neuroblastoma," and "esthesioneuroblastoma neck metastasis." Articles written in English with greater than 10 subjects that had data regarding the association of neck recurrence and mortality and/or the association of neck recurrence with Kadish stage were included for analysis. RESULTS Thirteen studies met inclusion criteria with information regarding the association of neck recurrence and mortality, and 15 studies had data associating neck recurrence and Kadish stage. The neck recurrence rate was 14.1% in studies analyzing mortality. Among those patients who developed regional metastases, mortality was 60%. Of patients without regional recurrence, the mortality rate from disease was 26% (P < 0.0001) and overall mortality was 32% (P < 0.0001). The rate of neck recurrence within each Kadish stage was 0%, 11%, 21%, and 18% for Kadish stages A, B, C, and D, respectively. The trend toward an increased incidence of neck recurrence from stage A to stage D is statistically significant, with P value 0.003. CONCLUSION The rate of neck recurrence in esthesioneuroblastoma is close to 15%. There is a strong association of recurrence with Kadish stage B and C. Mortality from disease in patients with recurrence in cervical lymph nodes is significant when compared to those who never develop neck disease. Prospective studies are needed to evaluate a potential role for elective neck dissection versus elective neck radiation for patients with esthesioneuroblastoma. LEVEL OF EVIDENCE N/A. Laryngoscope, 126:1373-1379, 2016.
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Affiliation(s)
- James G Naples
- Department of Otolaryngology, UConn Health, Farmington, Connecticut, U.S.A
| | - Jeffrey Spiro
- Department of Otolaryngology, UConn Health, Farmington, Connecticut, U.S.A
| | - Belachew Tessema
- Department of Otolaryngology, Connecticut Sinus Institute, UConn Health, Farmington, Connecticut, U.S.A
| | - Clinton Kuwada
- Department of Otolaryngology, Hartford Hospital Head and Neck Cancer Center, UConn Health, Farmington, Connecticut, U.S.A
| | - Chia-Ling Kuo
- Biostatistics Center, Community Medicine and Health Care, CT Institute for Clinical & Translational, Science, UConn Health, Farmington, Connecticut, U.S.A
| | - Seth M Brown
- Department of Otolaryngology, Connecticut Sinus Institute, UConn Health, Farmington, Connecticut, U.S.A
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Syndrome of inappropriate antidiuretic hormone secretion associated with olfactory neuroblastoma. J Craniofac Surg 2015; 24:2189-93. [PMID: 24220439 DOI: 10.1097/scs.0b013e3182a41c52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study reports a patient having olfactory neuroblastoma complicated by syndrome of inappropriate antidiuretic hormone secretion. Olfactory neuroblastoma is a rare tumor that begins in the olfactory membrane. Only 10 cases have been reported previously. Because of having nonspecific symptoms, most patients manifest at an advanced stage at the time of diagnosis. Olfactory neuroblastoma may show local invasion and/or distant metastasis. We demonstrated preoperatively clinical and biochemical parameters consistent with antidiuretic hormone syndrome turned to normal ranges after the treatment. Surgery, chemotherapy, and radiotherapy are the choices of treatment; among these, surgery is an indispensible treatment.
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Abstract
OBJECTIVES Esthesioneuroblastoma is an uncommon cancer of the nasal cavity. We describe the outcomes for 26 patients treated with curative intent with photon radiotherapy (RT) at the University of Florida. METHODS Between May 1972 and June 2007, 26 patients received RT for previously untreated esthesioneuroblastoma of the nasal cavity. Sixteen patients were males and 10 were females with a median age of 55 years (range, 3 to 82 y). The modified Kadish stage distribution was: B, 7 patients; C, 17 patients; and D, 2 patients. Treatment modalities included the following: definitive RT, 5 patients; preoperative RT, 2 patients; and postoperative RT after resection, 19 patients. Elective neck irradiation (ENI) was performed in 17 (71%) of 24 N0 patients. RESULTS Rates of local control, cause-specific survival, and absolute overall survival at 5 years were 79%, 72%, and 69%, respectively. Overall survival among patients treated with definitive RT was 20% at 5 years, compared with 81% among those who underwent surgery and adjuvant RT (P=0.01). One (6%) of 17 patients who received ENI developed a recurrence in the neck and was successfully salvaged. Ultimate neck control was 100% at 5 years for patients who received ENI versus 69% among those not receiving ENI (P=0.0173). CONCLUSIONS Resection combined with adjuvant RT is more effective than surgery or RT alone in the treatment of esthesioneuroblastoma. ENI reduces the risk of regional relapse in patients with Kadish stage B and C cancers.
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De Bonnecaze G, Lepage B, Rimmer J, Al Hawat A, Vairel B, Serrano E, Chaput B, Vergez S. Long-term carcinologic results of advanced esthesioneuroblastoma: a systematic review. Eur Arch Otorhinolaryngol 2014; 273:21-6. [PMID: 25323151 DOI: 10.1007/s00405-014-3320-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/01/2014] [Indexed: 11/25/2022]
Abstract
Surgical resection followed by radiotherapy can be considered like the optimal treatment modality for limited esthesioneuroblastoma. However, therapeutic management of locally advanced tumors remains a challenge. The aim of our study was to access and compare the oncologic results of the different treatment modalities in advanced esthesioneuroblastoma. We performed a systematic review using the Medline, and Cochrane database in accordance with PRISMA criteria and included all the cases of advanced esthesioneuroblastoma published between 2000 and 2013. We also retrospectively included 15 patients with an advanced esthesioneuroblastoma managed at our tertiary care medical center. Long-term survival rates defined as the time from diagnosis or randomization to the date of death or last follow-up were evaluated for each treatment with Kaplan-Meier survival curve analyses. 283 patients have been included. The mean follow-up was 78 months. Five-year highest survival rates were obtained in patients treated by surgery associated with radiotherapy. Ten-year highest survival rates were obtained in patients treated by the association of surgery, radiotherapy and chemotherapy (p = 0.0008). Within the surgical group, 5-year highest survival rates were obtained in patients treated by endoscopic resection (p = 0.003). Surgical resection combined with radiotherapy offers the gold standard of care. Adjuvant chemotherapy seems to improve the long-term survival in patients with locally advanced esthesioneuroblastoma. Endoscopic resection in advanced tumors should be discussed on a case-by-case basis.
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Affiliation(s)
- Guillaume De Bonnecaze
- Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, 24 Chemin de Pouvourville, 31059, Toulouse, France.
| | - B Lepage
- Epidemiology Unit, University of Toulouse, Toulouse, France
| | - J Rimmer
- Otolaryngology-Head and Neck Surgery Department, Monash Health, Melbourne, Australia
| | - A Al Hawat
- Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, 24 Chemin de Pouvourville, 31059, Toulouse, France
| | - B Vairel
- Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, 24 Chemin de Pouvourville, 31059, Toulouse, France
| | - E Serrano
- Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, 24 Chemin de Pouvourville, 31059, Toulouse, France
| | - B Chaput
- Plastic and Aesthetic Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| | - S Vergez
- Otolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, 24 Chemin de Pouvourville, 31059, Toulouse, France
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Lubojemska A, Borejko M, Czapiewski P, Dziadziuszko R, Biernat W. Of mice and men: olfactory neuroblastoma among animals and humans. Vet Comp Oncol 2014; 14:e70-82. [PMID: 25041470 DOI: 10.1111/vco.12102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/19/2014] [Accepted: 05/09/2014] [Indexed: 12/21/2022]
Abstract
Olfactory neuroblastoma (ONB) is a rare tumour of nasal cavity and paranasal sinuses that arises from the olfactory neuroepithelium and has unpredictable clinical course. As the sense of smell is phylogenetically one of the first senses and olfactory neuroepithelium is evolutionary conserved with striking similarities among different species, we performed an extensive analysis of the literature in order to evaluate the similarities and differences between animals and humans on the clinical, morphological, immunohistochemical, ultrastructural and molecular level. Our analysis revealed that ONB was reported mainly in mammals and showed striking similarities to human ONB. These observations provide rationale for introduction of therapy modalities used in humans into the veterinary medicine. Animal models of neuroblastoma should be considered for the preclinical studies evaluating novel therapies for ONB.
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Affiliation(s)
- A Lubojemska
- Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Gdansk, Poland
| | - M Borejko
- Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - P Czapiewski
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
| | - R Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - W Biernat
- Department of Pathomorphology, Medical University of Gdansk, Gdansk, Poland
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Gallagher KK, Spector ME, Pepper JP, McKean EL, Marentette LJ, McHugh JB. Esthesioneuroblastoma: updating histologic grading as it relates to prognosis. Ann Otol Rhinol Laryngol 2014; 123:353-8. [PMID: 24668054 DOI: 10.1177/0003489414526368] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Hyams grading system has been extensively used to predict prognosis in patients with esthesioneuroblastoma (ENB). However, most studies showing prognostic correlation group grading into I/II versus III/IV, essentially comparing low versus high grade. In addition, these studies include patients with variable treatment regimens, including some that were treated with chemoradiation alone. We aimed to determine whether additional histologic variables correlate with outcome with regard to disease free and overall survival in a series of patients universally treated with anterior skull base resection and +/- adjuvant chemoradiation. STUDY DESIGN A retrospective review of 27 patients with ENB was performed. METHODS The sections of tumor from these 27 patients were studied and reviewed with attention to percentage lobularity, degree of pleomorphism, degree of neurofibrillary matrix, and degree of apoptosis. In addition, the presence or absence of rosettes, necrosis, calcification, spindle cells, gland hyperplasia, and bone invasion were noted. Finally, the number of mitoses per high power field and the nature of chromatin (fine vs coarse) were recorded. The histopathologic features of these 27 ENBs were reviewed and correlated with clinical outcome. RESULTS There were 11 patients with recurrence (40.7% recurrence). There were 5 deaths (81.5% survival). The study cohort's mean overall survival was 158 months and the mean disease-free survival was 70.6 months. In terms of overall survival, necrosis and mitosis (#/10hpf) were significant but not when multivariate analysis was performed, these were not individually significant. In terms of disease-free survival, mitosis (#/10hpf) was significant but not on multivariate analysis. Gland hyperplasia was found to be a positive prognostic variable, associated with longer overall and disease-free survival, but only in combination with no spindle features and without necrosis. CONCLUSIONS An updated histologic grading system may provide more valuable prognostic information in patients with esthesioneuroblastoma treated with a standardized treatment paradigm.
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Affiliation(s)
- Kelly K Gallagher
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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22
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Herr MW, Sethi RKV, Meier JC, Chambers KJ, Remenschneider A, Chan A, Curry WT, Barker FG, Deschler DG, Lin DT. Esthesioneuroblastoma: an update on the massachusetts eye and ear infirmary and massachusetts general hospital experience with craniofacial resection, proton beam radiation, and chemotherapy. J Neurol Surg B Skull Base 2013; 75:58-64. [PMID: 24498591 DOI: 10.1055/s-0033-1356493] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022] Open
Abstract
Objectives To update the Massachusetts General Hospital (MGH) and Massachusetts Eye and Ear Infirmary (MEEI) experience in the management of esthesioneuroblastoma (ENB) with multimodality therapy and to reassess treatment outcomes and complications in a larger cohort with longer follow-up times. Design A retrospective chart review. Setting A tertiary referral center. Participants All patients presenting with ENB and managed at the MGH and MEEI from 1997 to 2013. Main Outcome Measures Disease-free and overall survival. Results Twenty-two patients were identified with an average follow-up of 73 months. Ten patients presented with Kadish stage B disease and 12 with stage C disease. A total of six patients (27%) developed regional metastases. Treatment for all patients included craniofacial resection (CFR) followed by proton beam irradiation with or without chemotherapy. The 5-year disease-free and overall survival rates were 86.4% and 95.2%, respectively, by Kaplan-Meier analysis. Negative margins were a significant factor in disease-free survival. One patient experienced severe late-radiation toxicity. Conclusions ENB is safely and effectively treated with CFR followed by proton beam irradiation. The high incidence of regional metastases warrants strong consideration for elective neck irradiation. Proton beam radiation is associated with lower rates of severe late-radiation toxicity than conventional radiotherapy.
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Affiliation(s)
- Marc W Herr
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States
| | - Rosh K V Sethi
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Joshua C Meier
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States
| | - Kyle J Chambers
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
| | - Aaron Remenschneider
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
| | - Annie Chan
- Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States ; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - William T Curry
- Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States ; Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Fred G Barker
- Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States ; Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Daniel G Deschler
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
| | - Derrick T Lin
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States ; Massachusetts Eye and Ear Infirmary/Massachusetts General Hospital Cranial Base Center, Boston, Massachusetts, United States
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Skull invaders: when surgical pathology and neuropathology worlds collide. J Neuropathol Exp Neurol 2013; 72:600-13. [PMID: 23771219 DOI: 10.1097/nen.0b013e318299c40f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Skull and dura serve as effective barriers to penetration by most tumors, often preventing masses originating intracranially from extending into the contiguous bone and soft tissues, or those arising in head and neck regions from extending into the dura and brain tissue. We review our 15-year experience with extracranial tumors that had sufficiently invaded adjacent skull, dura, or brain from the "outside-in" to require a neurosurgeon to participate in the surgical resection and discuss our 40 cases in context with the literature. Sinonasal-origin tumors (n = 17) and cutaneous tumors (n = 10) were the most frequent skull-invaders. Most of the cutaneous tumor types were squamous cellcarcinomas (n = 9); diverse sinonasal-origin types included 4 squamous cell carcinomas, 4 adenoid cystic carcinomas, 2 sinonasal undifferentiated carcinomas, 2 sinonasal adenocarcinomas, and single examples each of sinonasal-origin hemangiopericytoma, solitary fibrous tumor, melanoma, mucocele, and teratocarcinoma. There were 9olfactory neuroblastomas, and middle ear-origin basal cell carcinoma,recurrent glomus jugulare, and orbital malignant hidradenoma were also seen. Unique tumors included a cutaneous cylindroma invasive of skull convexity occurring in familial cylindromatosis and a ganglioneuroma of the middle ear with massive bilateral skull base extension. Convexity dural spread, a seldom-reported pattern of dissemination, was seen in 1 olfactory neuroblastoma and 1 adenoid cystic carcinoma. The ability to show skull/dural invasion did not correlate with specific histopathologic features; even benign tumor types can show skull/dural penetration.
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Patel KS, Komotar RJ, Szentirmai O, Moussazadeh N, Raper DM, Starke RM, Anand VK, Schwartz TH. Case-specific protocol to reduce cerebrospinal fluid leakage after endonasal endoscopic surgery. J Neurosurg 2013; 119:661-8. [DOI: 10.3171/2013.4.jns13124] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Endoscopic transsphenoidal surgery is expanding in acceptance, yet postoperative CSF leak rates remain a concern. This study presents the Cornell closure protocol, which has yielded significantly lower postoperative CSF leak rates compared with prior reports, as an algorithm that can be used by centers having difficulty with CSF leak.
Methods
A single closure algorithm for endoscopic surgery has been used since January 2010 at Weill Cornell Medical College. A prospective database noting intraoperative CSF leak, closure technique, and postoperative CSF leak was reviewed. The authors used a MEDLINE search to identify similar studies and compared CSF leak rates to those of patients treated using the Cornell algorithm.
Results
The retrospective study of a prospectively acquired database included 209 consecutive patients. In 84 patients (40%) there was no intraoperative CSF leak and no postoperative CSF leak. In the 125 patients (60%) with an intraoperative CSF leak, 35 of them with high-flow leaks, there were 0 (0%) postoperative CSF leaks.
Conclusions
It is possible to achieve a CSF leak rate of 0% by using this closure protocol. With proper experience, endoscopic skull base surgery should not be considered to have a higher CSF leak rate than open transcranial or microscopic transsphenoidal surgery.
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Affiliation(s)
| | - Ricardo J. Komotar
- 2Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | | | | | - Daniel M. Raper
- 3Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert M. Starke
- 3Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - Theodore H. Schwartz
- 1Departments of Neurosurgery,
- 4Otolaryngology, and
- 5Neurology and Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Kamal E, El-Fattah AMA, Emam H, Kassem M, Elashry M, Abd Elwahab AEM, Tawfik A. Esthesioneuroblastoma: Mansoura University Hospitals’ experience with multimodality therapy in 10years. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.ejenta.2012.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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[Esthesioneuroblastoma]. Bull Cancer 2013; 99:1197-207. [PMID: 23022763 DOI: 10.1684/bdc.2012.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Esthesioneuroblastoma is an uncommon malignancy originating from olfactive epithelium. Men are more frequently affected than women. Nasal symptoms are the most common revealing signs. Immunohistochemistry helps diagnosis. There is no randomized trial evaluating treatment due to the low incidence of this tumor. Radiotherapy and surgery are the standard of care. Radiotherapy is benefic even in early stage disease. Chemotherapy is indicated in case of locally advanced or metastatic disease.
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Kaur G, Kane AJ, Sughrue ME, Madden M, Oh MC, Sun MZ, Safaee M, El-Sayed I, Aghi M, McDermott MW, Berger MS, Parsa AT. The prognostic implications of Hyam's subtype for patients with Kadish stage C esthesioneuroblastoma. J Clin Neurosci 2012; 20:281-6. [PMID: 23266076 DOI: 10.1016/j.jocn.2012.05.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/12/2012] [Indexed: 10/27/2022]
Abstract
Esthesioneuroblastoma (EN) is a rare sinonasal tumor with varied aggressiveness and potential for intracranial invasion. EN is staged anatomically with radiographic evaluation using the Kadish staging system (stages A, B, and C) and histologically by using Hyam's criteria (grades 1-4). Here we show that despite radiographic evidence of aggressive features, the prognosis of patients with Kadish stage C EN is best predicted by tumor histology using Hyam's criteria. We retrospectively analyzed patients with EN with Kadish stage C who were evaluated and treated at our institution between 1995 and 2009. Clinical information was collected using patient medical records, imaging, and review of pathological specimens. Twenty patients with Kadish stage C EN were identified with mean age of 51 years (31-70 years) with a median follow-up of 41.4 months (1.3-175 months). Upon pathological review, 44.4% of patients had low-grade (1/2) and 55.6% had high-grade (3/4) histology. About 37.5% of patients with low-grade EN had undergone gross total resection (GTR) and the remaining 62.5% had GTR and adjuvant radiation, whereas 50% of patients with high-grade ER had undergone GTR, 20% had undergone GTR and adjuvant radiation, and 30% had been treated with a subtotal resection (STR) and adjuvant radiation. The 5-year and 10-year survival in patients with low-grade EN was 86% in comparison to 56% and 28% with high-grade EN, respectively. In patients with low-grade EN, the 2-year progression free survival (PFS) was 86% and the 5-year PFS was 65% in comparison to 73% and 49% in patients with high-grade EN, respectively. The patient's tumor histology (Hyam's criteria) appeared to be the best way of predicting the prognosis and for selecting patients for adjuvant radiotherapy.
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Affiliation(s)
- Gurvinder Kaur
- Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal compared with anterior craniofacial and combined cranionasal resection of esthesioneuroblastomas. World Neurosurg 2012; 80:148-59. [PMID: 23228365 DOI: 10.1016/j.wneu.2012.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 08/19/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Esthesioneuroblastomas represent a surgical challenge because of their anatomical location, the necessity of achieving negative margins, and the often-cosmetically disfiguring transfacial approaches needed. Recently, expanded endonasal endoscopic approaches have been developed, either alone or in combination with a craniotomy. We conducted a systematic review of case series and case reports to compare outcomes between these various surgical approaches. METHODS A MEDLINE search was conducted of the modern literature (1985-2010) to identify open and endoscopic surgical series. Tumor and patient characteristics, Kadish stage, extent of resection, and progression-free and overall survival were recorded and analyzed by approach. Kaplan-Meier analysis was used to assess overall survival and progression-free survival. RESULTS Forty-seven studies comprising 453 patients were included. The endoscopic cohort had a greater proportion of Kadish Stage A tumors compared with the craniofacial group. Gross total resection was achieved in 98.1% of patients who underwent an endoscopic approach compared with 81.3% for the craniofacial and 100% for the cranionasal cohorts. Local recurrence occurred in 8.0% of patients in the endoscopic group compared with 22.1% in the craniofacial and 16.7% in the cranionasal cohorts. CONCLUSION In well-selected cases, cranionasal and endonasal approaches can be safe and effective. An ongoing evaluation of the benefits and limitations are necessary to better define the ideal patient population and patient-specific risk factors for the use of these minimal access techniques.
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Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Goh CHK, Chua DYK, Ho RLW, Chan C. Esthesioneuroblastomas in an Asian population: similarities and differences. Asian J Surg 2012; 35:154-8. [PMID: 23063088 DOI: 10.1016/j.asjsur.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 04/27/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Esthesioneuroblastoma is an uncommon tumor that is described widely among the Caucasians. In Singapore, we see predominantly Asian patients with esthesioneuroblastomas. From our experience, we note significant and interesting differences between our data on Asian patients and the published ones on the Caucasian patients. METHODS A retrospective review of all patients who underwent craniofacial resection for esthesioneuroblastomas was conducted from January 1997 to January 2010. Relevant data were collected and statistical analyses were carried out to determine factors that predicted mortality or complications. RESULTS Out of a total of 48 patients who underwent craniofacial resections, half had esthesioneuroblastomas (50%). There was a peak age distribution at the sixth decade of life and 62% of our patients were male. Both local and regional recurrence rate was 50%. CONCLUSION Majority of our Asian patients who underwent craniofacial resections had esthesioneuroblastomas. There is a male predilection, and we do not see a bimodal age distribution that is commonly reported.
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Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic skull base surgery: a comprehensive comparison with open transcranial approaches. Br J Neurosurg 2012; 26:637-48. [PMID: 22324437 DOI: 10.3109/02688697.2012.654837] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little data exists comparing endoscopic endonasal approaches to pathology of the anterior skull base with more traditional transcranial and transsphenoidal microscopic approaches. In order to more fully characterize the role of endoscopy in the management of pathology of the anterior cranial base, we conducted a systematic review of case series and case reports documenting surgical and clinical outcomes. We found that for craniopharyngiomas, clival chordomas, esthesioneuroblastomas and giant pituitary adenomas, the endonasal endoscopic approach can result in equivalent or higher rates of gross total resection than open approaches. For meningiomas, however, open transcranial approaches are still able to achieve higher rates of total resection. CSF leak rates are higher for patients undergoing endoscopic surgery for meningiomas and craniopharyngiomas, but not for chordomas, esthesioneuroblastomas or giant pituitary adenomas. In certain patients, the endonasal endoscopic approach may be a safe and effective alternative for the treatment of a wide variety of skull base pathology, particularly those with small midline tumours.
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Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
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Vigliano FA, Marcaccini AJ, Sarradell J, Bermúdez R, Quiroga MI. First description of an olfactory neuroblastoma in goldfish Carassius auratus: a case report. DISEASES OF AQUATIC ORGANISMS 2011; 96:61-68. [PMID: 21991666 DOI: 10.3354/dao02383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An external pinkish growing mass that emerged from the right nostril of an adult goldfish Carassius auratus L. was evaluated by means of light microscopy and immunohistochemistry. The neoplasm presented a well-developed fibrovascular stroma associated with solid cell nests and a large number of Flexner-Wintersteiner rosettes. Myelinated fibres were observed around them. Neoplastic cells showed a prominent degree of nuclear atypia and low mitotic activity. The latter was in agreement with the low reactivity of tumour cells to anti-proliferating cell nuclear antigen antibody. Immunohistochemistry also revealed anti-neuronal nitric oxide synthase, anti-S100 protein, antineuropeptide Y, and anti-cytokeratin immunoreactivity in tumour cells as well as in normal olfactory epithelium of goldfish control sections. Histopathological and immunohistochemical findings strongly suggest a diagnosis of an olfactory neuroblastoma (ONB). To our knowledge this is the first description of ONB in goldfish.
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Affiliation(s)
- F A Vigliano
- Cátedra de Histología y Embriología, Facultad de Ciencias Veterinarias, Universidad Nacional de Rosario, S2170HGJ Casilda, Argentina.
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Jiang GY, Li FC, Chen WK, Liu AM, Cai WQ. Therapy and prognosis of intracranial invasive olfactory neuroblastoma. Otolaryngol Head Neck Surg 2011; 145:951-5. [PMID: 21825099 DOI: 10.1177/0194599811416752] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There is currently no consensus on a standardized treatment strategy for olfactory neuroblastoma (ONB), especially for intracranial invasion. This purpose of this study is to explore the appropriate treatment modality and prognostic factors of intracranial invasive ONB. STUDY DESIGN Case series with chart review. SETTING The study was conducted at the Sun Yat-sen Memorial Hospital and the Cancer Center of Sun Yat-sen University, China. SUBJECTS AND METHODS Twenty-five cases of intracranial invasive ONB were collected and investigated using a retrospective review analysis from patients diagnosed between 1980 and 2005. RESULTS The 1-, 3-, and 5-year overall survival rates for the group were 55%, 46%, and 31%, respectively. The subgroups who did not receive surgical treatment had worse survival rates than those who did receive treatment. In particular, patients who did not receive any therapy did not live past 1 year. In contrast, the group of patients treated by intranasal resection in combination with radiotherapy and/or chemotherapy showed a slightly better survival rate. It is important to note that the group of patients treated by craniofacial surgery combined with radiotherapy and/or chemotherapy had a markedly favorable prognosis, with 1-, 3-, and 5-year overall survival rates of up to 100%, 88%, and 66%, respectively. CONCLUSIONS Craniofacial surgery in combination with radiotherapy and/or chemotherapy was an effective treatment for intracranial invasive ONB. In addition, it was found that age may not be an important prognostic factor for intracranial invasive ONB; however, the rate of intracalvarial invasion was found to be a potent marker for predicting the prognosis of patients.
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Affiliation(s)
- Guang-Yi Jiang
- Department of Neurosurgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Brosinski K, Janik D, Polkinghorne A, Von Bomhard W, Schmahl W. Olfactory neuroblastoma in dogs and cats--a histological and immunohistochemical analysis. J Comp Pathol 2011; 146:152-9. [PMID: 21783199 DOI: 10.1016/j.jcpa.2011.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 05/17/2011] [Accepted: 06/06/2011] [Indexed: 01/24/2023]
Abstract
Olfactory neuroblastoma (ONB) was identified in 13 dogs and nine cats. The tumours were subjected to microscopical examination and were graded using a human pathological grading system. In the canine and feline tumours there was more necrosis and higher mitotic activity (mitotic index and Ki67 labelling index) than reported in human ONB. Rosettes were a common feature of feline ONBs. A significant correlation was observed between the histological grade and the Ki67 labelling index. The histopathological diagnosis of ONB was confirmed immunohistochemically by demonstration of the neuronal marker neuron-specific enolase (NSE). Two other neuron-specific antibodies specific for microtubule-associated protein-2 (MAP-2) and neuronal nuclei antigen (NeuN) were evaluated. MAP-2 expression proved to have higher specificity than labelling for NSE. NeuN expression was less sensitive and of limited practical value.
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Affiliation(s)
- K Brosinski
- Chair of General Pathology and Neuropathology, Institute of Veterinary Pathology, Ludwig-Maximilians University, Veterinärstr. 13, D-80539 Munich, Germany.
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Nichols AC, Chan AW, Curry WT, Barker FG, Deschler DG, Lin DT. Esthesioneuroblastoma: the massachusetts eye and ear infirmary and massachusetts general hospital experience with craniofacial resection, proton beam radiation, and chemotherapy. Skull Base 2011; 18:327-37. [PMID: 19240832 DOI: 10.1055/s-2008-1076098] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the efficacy of craniofacial resection and proton radiation for the management of esthesioneuroblastoma (ENB). DESIGN A retrospective chart review was performed of all patients presenting with ENB and completely managed at the Massachusetts General Hospital (MGH) and the Massachusetts Eye and Ear Infirmary (MEEI) from 1997 to 2006. SETTING A tertiary referral center. MAIN OUTCOME MEASURES Disease-free and overall survival. PARTICIPANTS All patients presenting with ENB and completely managed at the MGH and the MEEI from 1997 to 2006. RESULTS Ten patients were identified with a median follow-up time of 52.8 months. Average age at presentation was 45 years. Nasal obstruction was the most common presenting symptom. Three patients presented with Kadish stage B disease and seven with stage C. No patient had evidence of cervical or metastatic disease at presentation. Seven patients were treated with craniofacial resections (CFR) followed by proton beam radiation with or without chemotherapy. Three patients were treated with initial chemotherapy with no response. They subsequently underwent CFR followed by proton beam radiation. The 5-year disease-free and overall survival rates were 90% and 85.7%, respectively, by Kaplan-Meier analysis. No patient suffered any severe radiation toxicity. CONCLUSION ENB can be safely and effectively treated with CFR followed by proton beam irradiation. Proton irradiation may be associated with less toxicity than photon irradiation. The role of chemotherapy remains unclear.
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Affiliation(s)
- Anthony C Nichols
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Demiroz C, Gutfeld O, Aboziada M, Brown D, Marentette LJ, Eisbruch A. Esthesioneuroblastoma: is there a need for elective neck treatment? Int J Radiat Oncol Biol Phys 2011; 81:e255-61. [PMID: 21676553 DOI: 10.1016/j.ijrobp.2011.03.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 02/13/2011] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the risk of cervical lymph node metastases after definitive treatment for esthesioneuroblastoma (ENB) that did not include elective neck therapy. METHODS AND MATERIALS This was a retrospective analysis of 26 ENB patients treated at the University of Michigan between 1995 and 2007. Tumor stage was Kadish A in 1 patient, B in 19, C in 5, and unknown in 1. Craniofacial or subcranial resection was performed in 24 patients (92%), with negative margins in 22 (92%). Postoperative radiotherapy (RT) to the primary site was given in 12 patients (46%), and 14 patients (54%) had surgery alone. All patients had clinically N0 disease, and no patient underwent elective neck dissection or radiation. Median follow-up was 72 months. RESULTS Local relapse-free survival was significantly better for patients who received postoperative RT compared with those who had surgery alone: 100% vs. 29% at 5 years, respectively (p = 0.005). Five-year disease-free survival was 87.5% in the RT group vs. 31% in the surgery-alone group (p = 0.05). Regional failure was observed in 7 patients (27%), 6 with Kadish Stage B and 1 with Stage C disease. The most common site of nodal failure was Level II, and 3 patients failed in the contralateral neck. Only 3 patients with regional failure were successfully salvaged. CONCLUSION The high rate of regional failures when the neck is not electively treated justifies elective nodal RT in patients with both Kadish Stages B and C. In addition, our experience confirms the beneficial effect on local control of adjuvant RT to the tumor bed.
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Affiliation(s)
- Candan Demiroz
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
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Higgins TS, Thorp B, Rawlings BA, Han JK. Outcome results of endoscopic vs craniofacial resection of sinonasal malignancies: a systematic review and pooled-data analysis. Int Forum Allergy Rhinol 2011; 1:255-61. [PMID: 22287429 DOI: 10.1002/alr.20051] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 12/23/2010] [Accepted: 01/04/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Endoscopic approaches of sinonasal malignancies are now being described. This study aims to conduct a systematic review with a pooled-data analysis to compare outcomes of endoscopic vs craniofacial resection of sinonasal malignancies. METHODS A search was conducted of MEDLINE (1966-2008), EMBASE (1980-2008), Cochrane Central Register of Clinical Trials (CENTRAL), Cochrane Database of Systematic Reviews, clinicaltrials.gov, and The National Guideline Clearinghouse databases and supplemented by references in retrieved articles. All authors used a detailed list of inclusion and exclusion criteria to determine articles eligible for final inclusion. The authors extracted data regarding study criteria appraisal, sinonasal malignancy characteristics, survival outcomes, and recurrence. Kaplan-Meier survival and locoregional control rates were calculated and compared using the log-rank test. RESULTS Of the 2314 citations reviewed, the search yielded 15 case series with individual data on 226 patients. The most common malignancies were esthesioneuroblastoma (47%), adenocarcinoma (24%), and undifferentiated carcinoma (22%). The overall 5-year survival rate for the sample was 56.5% (standard error [SE] ± 3.8). Because of the paucity of data with endoscopic resection of high-stage malignancies, the outcome results were highly variable and no useful comparison could be made. Among low-stage malignancies (T1-2 or Kadish A-B), the endoscopic and open approaches demonstrated no statistically significant difference in outcome results. The 5-year overall survival was 87.4% (SE ± 5.3) in the endoscopic group vs 76.8% (SE ± 8.3) for open approaches (p = 0.351); disease-specific survival was 94.7% (SE ± 3.7) vs 87.7% (SE ± 6.7; p = 0.258); and locoregional control rate was 89.5% (SE ± 5.0) vs 77.2% (SE ± 10.4; p = 0.251). CONCLUSION Transnasal endoscopic resection appears to be a reasonable alternative to craniofacial resection in the management of low-stage sinonasal malignancies.
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Affiliation(s)
- Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Endoscopic Sinus, and Skull Base Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
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Küpeli S, Yalçin B, Büyükpamukçu M. Olfactory neuroblastoma in children: results of multimodality treatment in 2 patients. Pediatr Hematol Oncol 2011; 28:56-9. [PMID: 21247350 DOI: 10.3109/08880018.2010.514656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Olfactory neuroblastoma, a rare malignancy of the olfactory epithelium, is an uncommon tumor in children. It occurs mostly in older individuals and the treatment strategies are based on the experience with adults. In this report, clinical characteristics and treatment results of 2 patients with olfactory neuroblastoma are described and discussed with those reported in the literature.
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Affiliation(s)
- Serhan Küpeli
- Department of Pediatric Oncology, Institute of Oncology, Hacettepe University, Ankara, Turkey.
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Muñoz F, Tresserras P, Bartumeus F, Montserrat J, Sancho F. Estudio retrospectivo de 11 casos de estesioneuroblastomas tratados en el Hospital Santa Creu i Sant Pau entre los años 2000 y 2008 más revisión de la literatura. Neurocirugia (Astur) 2011. [DOI: 10.1016/s1130-1473(11)70035-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Aggarwal SK, Kumar R, Shrivastav A, Keshri A, Sharma P. Esthesioneuroblastoma presenting with proptosis and bilateral neck metastasis: An unusual presentation. J Pediatr Neurosci 2011; 6:78-81. [PMID: 21977098 PMCID: PMC3173925 DOI: 10.4103/1817-1745.84417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Esthesioneuroblastoma (ENB) presenting simultaneously with proptosis and bilateral neck metastasis is a very rare presentation. ENB is a rare tumor arising from the olfactory epithelium of the nasal vault which frequently invades the cranial base, cranial vault and orbit. ENB has a bimodal age distribution between 11 and 20 years and between 51 and 60 years. ENB accounts for approximately 1 to 5% of intranasal cancers and no consensus has been reached yet regarding the treatment of this tumor. We are reporting a 17-year-old male patient who presented with right eye proptosis with loss of vision and bilateral neck metastasis. Contrast enhanced computed tomography (CECT) and magnetic resonance imaging (MRI) was done which showed Kadish stage C tumor. Nasal biopsy was done to make the diagnosis and the patient was subjected to radiotherapy. Tumor responded to radiotherapy and both the primary lesion and the cervical lymph node metastasis disappeared. The purpose of this study is to report the rare presentation of proptosis along with bilateral cervical lymph node metastasis in this rare sinonasal tumor.
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Affiliation(s)
| | - Raj Kumar
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Arun Shrivastav
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Amit Keshri
- Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Pankaj Sharma
- Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
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Smee RI, Broadley K, Williams JR, Meagher NS, Bridger GP. Retained role of surgery for olfactory neuroblastoma. Head Neck 2010; 33:1486-92. [PMID: 21928422 DOI: 10.1002/hed.21644] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 08/29/2010] [Accepted: 09/06/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Olfactory neuroblastoma is a rare paranasal sinus malignancy. The traditional approach was craniofacial resection (CFR) and then postoperative radiotherapy until 1998. This review will chart development of a new protocol. METHODS This ethics-approved audit evaluated the number of new patients diagnosed with olfactory neuroblastoma, with information relating to patient, disease, and treatment factors noted. RESULTS There were 24 eligible patients, 16 men, 8 women, 7 Kadish stage B, 17 stage C. The planned treatment was: chemotherapy (cisplatin/etoposide) and determine treatment dependent on response in 6 patients, surgery and radiotherapy in 16 patients, and single-modality treatment only (surgery, radiotherapy 1) in 2 patients. Surgery to radiotherapy occurred in 17 patients. With salvage treatment ultimate local control was 79%. CONCLUSIONS There was a higher local control in those patients who had surgery; abandoning this may carry a higher risk of local failure. The use of response to chemotherapy to determine local treatment remains experimental.
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Affiliation(s)
- Robert I Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Randwick, New South Wales, Australia.
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Kane AJ, Sughrue ME, Rutkowski MJ, Aranda D, Mills SA, Buencamino R, Fang S, Barani IJ, Parsa AT. Posttreatment prognosis of patients with esthesioneuroblastoma. J Neurosurg 2010; 113:340-51. [PMID: 20345216 DOI: 10.3171/2010.2.jns091897] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT There is no Class I evidence to guide the appropriate management of esthesioneuroblastoma (EN). Most data currently guiding treatment come from small- or modest-sized series gathered at individual centers that have concluded that surgery with radiotherapy is the preferred treatment. In this study, the authors summarize the published literature on treatment outcomes in patients with EN. The objective was to ascertain what variables predict prognosis in these patients and to determine the relative effect of different therapies. METHODS The authors identified 205 published studies containing treatment outcomes for surgery, radiotherapy, chemotherapy, or multimodal treatment. Using Kaplan-Meier analysis, the survival of patients who received surgery was compared with that in those who received surgery and radiotherapy. Additionally, Kadish staging was compared with low- and high-grade Hyams criteria to assess for subgroup prognostic significance in survival differences. RESULTS Nine hundred fifty-six patients met the inclusion criteria, with a median follow-up time of 3 years. Kaplan-Meier analysis demonstrated no difference in survival between patients who underwent surgery alone and those who underwent surgery plus radiotherapy at 5 years (78 vs 75%) or 10 years (67 vs 61%, respectively) (p = 0.3). Univariate analysis demonstrated worse survival in cases involving Kadish Grade C tumors, Hyams Grade 3 and 4 tumors, and in patients older than 65 years of age. Multivariate analysis demonstrated that Hyams Grade 3 and 4 lesions carried significant risk (proportional hazard = 4.83, p < 0.001) with 5- and 10-year survival of 47 and 31%. CONCLUSIONS A biopsy should always be obtained in cases suspected of EN because histology is a strong prognostic indicator and will help guide appropriate treatment. Unimodal surgery and combined surgery/radiotherapy appear to be of equivalent efficacy with respect to survival in patients with EN. Chemotherapy should be considered in high-grade EN.
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Affiliation(s)
- Ari J Kane
- Department of Neurological Surgery, University of California, San Francisco, California 94143, USA
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Noh OK, Lee SW, Yoon SM, Kim SB, Kim SY, Kim CJ, Jo KJ, Choi EK, Song SY, Kim JH, Ahn SD. Radiotherapy for esthesioneuroblastoma: is elective nodal irradiation warranted in the multimodality treatment approach? Int J Radiat Oncol Biol Phys 2010; 79:443-9. [PMID: 20421144 DOI: 10.1016/j.ijrobp.2009.10.067] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 10/26/2009] [Accepted: 10/30/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) has not been clearly defined. We analyzed treatment outcomes of patients with ENB and the frequency of cervical nodal failure in the absence of ENI. METHODS AND MATERIALS Between August 1996 and December 2007, we consulted with 19 patients with ENB regarding radiotherapy. Initial treatment consisted of surgery alone in 2 patients; surgery and postoperative radiotherapy in 4; surgery and adjuvant chemotherapy in 1; surgery, postoperative radiotherapy, and chemotherapy in 3; and chemotherapy followed by radiotherapy or concurrent chemoradiotherapy in 5. Five patients did not receive planned radiotherapy because of disease progression. Including 2 patients who received salvage radiotherapy, 14 patients were treated with radiotherapy. Elective nodal irradiation was performed in 4 patients with high-risk factors, including 3 with cervical lymph node metastasis at presentation. RESULTS Fourteen patients were analyzable, with a median follow-up of 27 months (range, 7-64 months). The overall 3-year survival rate was 73.4%. Local failure occurred in 3 patients (21.4%), regional cervical failure in 3 (21.4%), and distant failure in 2 (14.3%). No cervical nodal failure occurred in patients treated with combined systemic chemotherapy regardless of ENI. Three cervical failures occurred in the 4 patients treated with ENI or neck dissection (75%), none of whom received systemic chemotherapy. CONCLUSIONS ENI during radiotherapy for ENB seems to play a limited role in preventing cervical nodal failure. Omitting ENI may be an option if patients are treated with a combination of radiotherapy and chemotherapy.
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Affiliation(s)
- O Kyu Noh
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Gudziol V, Paech I, Hummel T. Unilateral reduced sense of smell is an early indicator for global olfactory loss. J Neurol 2010; 257:959-63. [DOI: 10.1007/s00415-009-5445-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 12/08/2009] [Accepted: 12/21/2009] [Indexed: 11/29/2022]
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Esthesioneuroblastoma methods of intracranial extension: CT and MR imaging findings. Neuroradiology 2009; 51:841-50. [PMID: 19669739 DOI: 10.1007/s00234-009-0581-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Esthesioneuroblastoma (ENB) is an aggressive neuroectodermal malignancy in the upper nasal cavity with local infiltration and lymphatic or hematogenous metastasis. The purpose of this paper is to document three types of direct intracranial extensions by ENB using computed tomography (CT) and magnetic resonance imaging (MRI). METHODS Eleven patients with pathologically confirmed ENB were admitted in our hospital between December 2002 and December 2008. Their magnetic resonance (MR; n = 10) and CT (n = 8) images were retrospectively reviewed, and particular attention was paid to tumor location and extension, enhancement pattern, cervical lymph node metastasis, and Kadish stage. RESULTS The majority of patients were male (8/11) with Kadish stage C tumor (10/11). Three types of direct intracranial extension by ENBs were put forward according to their MR and CT findings. The primary tumors were well-defined soft-tissue masses centered in the roof of the nasal cavity eroding into the paranasal sinuses (11/11), the contralateral nasal cavity (4/11), the cranial cavity (5/11), and the fossa orbitalis (3/11). The tumor parenchyma were hypointensity on T1-weighted images, heterogeneous hyperintensity on T2-weighted images, and isodensity or slight hyperdensity on CT images with scattered necroses (4/11) and marginal cysts(4/11). Their enhancements were significant and inhomogeneous. Cervical lymph nodes metastases were observed in four patients (4/11), but no pathologically proved distant metastasis was observed. CONCLUSION Three types of direct intracranial extensions by ENB can be found on CT and MRI: cranio-orbital-nasal-communicating ENB, cranio-nasal-communicating ENB, and orbital-nasal-communicating ENB.
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Devaiah AK, Andreoli MT. Treatment of esthesioneuroblastoma: a 16-year meta-analysis of 361 patients. Laryngoscope 2009; 119:1412-6. [PMID: 19444891 DOI: 10.1002/lary.20280] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study reviews the published outcomes related to surgical (open, endoscopic, and endoscopic-assisted) and nonsurgical treatment for esthesioneuroblastoma. STUDY DESIGN Literature meta-analysis. METHODS A meta-analysis of individual patient data for esthesioneuroblastoma publications between 1992 (the earliest identified description of endoscopic resection) and 2008 was conducted. A total of 49 journal articles, comprising 1,170 cases of esthesioneuroblastoma, were included in the study. Criteria for meta-analysis inclusion were five or more patients in a study with sufficient patient data resolution for analysis. Twenty-three studies comprising 361 patients met all inclusion criteria. The overall treatment and outcome at final follow-up of each patient was recorded. Patients were pooled according to treatment techniques and compared to one another using a Kaplan-Meier survival curve and the Mann-Whitney U test to examine differences in follow-up times and publication years. RESULTS Log-rank tests showed a greater published survival rate for endoscopic surgery compared to open surgery (P = .0019), even when stratifying for publication year (P = .0018). There was no significant difference in follow-up time. Review of Kadish tumor staging for each modality showed larger tumors were more often treated with an open approach, but open and endoscopic survival measures were comparable. CONCLUSIONS These results suggest that endoscopic surgery is a valid treatment method with comparable survival to open surgery. Further prospective analysis will be beneficial.
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Affiliation(s)
- Anand K Devaiah
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Bragg TM, Scianna J, Kassam A, Emami B, Brown HG, Hacein-Bey L, Clark JI, Muzaffar K, Boulis N, Prabhu VC. Clinicopathological review: esthesioneuroblastoma. Neurosurgery 2009; 64:764-70; discussion 770. [PMID: 19349835 DOI: 10.1227/01.neu.0000338948.47709.79] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Taryn McFadden Bragg
- Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
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Arnold PM, Habib A, Newell K, Anderson KK. Esthesioneuroblastoma metastatic to the thoracic intradural and extradural space. Spine J 2009; 9:e1-5. [PMID: 18805062 DOI: 10.1016/j.spinee.2008.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 06/04/2008] [Accepted: 08/05/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Ethesioneuroblastoma (ENB) is a rare tumor of the olfactory epithelium that has been shown to metastasize mostly to the cervical lymphatics, with only infrequent spread to other locations. We report a rare case of ENB characterized by recurrence and distant metastasis to the T7-T8 intradural and extradural space. PURPOSE To report a rare case of recurrent ENB metastatic to the thoracic intradural and extradural space. STUDY DESIGN/SETTING Case report with a review of the literature. METHODS A 64-year-old man with recurrent ENB presented with chronic pain in the neck, shoulder, and back. His neurologic exam was normal. Computed tomography of the chest showed no pulmonary metastasis and a high-attenuation spinal canal mass at T8 was noted on magnetic resonance imaging. A laminectomy at T7-T8 was performed for resection of a large epidural mass. A tumor was seen penetrating through the dura, and a midline durotomy was performed for resection of a large intradural mass. Frozen section and permanent stains were consistent with metastatic ENB. RESULTS The postoperative period was uneventful, and included pain management and physical therapy, followed by chemotherapy and radiation. The patient remains free of spinal recurrence 2 years after surgery. CONCLUSIONS Metastasis of ENB to the spinal column is rare, and of those instances, 80% are localized to the cauda equina. Recurrent ENB metastatic to the thoracic intradural and extradural space is extremely rare, and was successfully treated with surgical resection.
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Affiliation(s)
- Paul M Arnold
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3021, Kansas City, KS 66160-0001, USA.
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Wigand ME, Iro H, Bozzato A. Transcranial combined neurorhinosurgical approach to the paranasal sinuses for anterior skull base malignancies. Skull Base 2009; 19:151-8. [PMID: 19721771 PMCID: PMC2671301 DOI: 10.1055/s-0028-1096200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Various transcranial and transfacial approaches have been described and each claims to provide the best exposure to the anterior skull base. Similarly, each approach claims the best outcomes following the resection of anterior skull base malignancies. We have always advocated a combined neurorhinological approach for the management of paranasal sinus malignancies that infiltrate the skull base, such as esthesioneuroblastomas. MATERIALS AND METHODS At the outset, the technique was developed on cadaver specimens, imitating the limitations that might be imposed in the real-life situation when undertaking endoscopic sinus surgery. Additional exposure of the anterior cerebral fossa was achieved using a classical bifrontal approach. Starting with endoscopic or microscopic unroofing of the ethmoids, all relevant landmarks were identified. The frontal, sphenoid, and maxillary sinuses were then opened using endoscopic techniques. RESULTS The dissections proved that a broad exposure of the anterior skull base could be combined with clear endoscopic visualization of the nasal cavity and of all the paranasal sinuses from above. This facilitated complete eradication of lesions from the sinuses cavities, their walls, and the intracranial tumor. DISCUSSION The combined neurorhinosurgical transcranial approach to the anterior skull base and nasal and paranasal sinuses, avoiding trans-facial approaches, enables a multidiciplinary team to resect malignant tumors of the anterior skull base directly without unnecessary destruction of facial structures. It appears to provide better access than other more destructive methods like midfacial degloving or subfrontal approaches. Our single-stage approach also facilitates safe and effective reconstruction of the skull base. The technique can be employed for tumors of all sizes and is also used for orbital resections and decompression of the optic nerve and chiasma.
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Affiliation(s)
- Malte Erik Wigand
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, FAU Medical School, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, FAU Medical School, Erlangen, Germany
| | - Alessandro Bozzato
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, FAU Medical School, Erlangen, Germany
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Bachar G, Goldstein DP, Shah M, Tandon A, Ringash J, Pond G, Gullane PJ, Perez-Ordonez B, Gilbert RW, Brown DH, Gentili F, O'Sullivan B, Irish JC. Esthesioneuroblastoma: The Princess Margaret Hospital experience. Head Neck 2009; 30:1607-14. [PMID: 18798301 DOI: 10.1002/hed.20920] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Esthesioneuroblastoma is rare. The aim of the study was to review our experience and to evaluate the staging system and treatment that best correlates with the patient outcome. METHODS Thirty-nine patients were identified between 1972 and 2006. RESULTS At presentation 10% had cervical metastases. None had distant metastasis. Five were treated with surgery, 2 with chemotherapy, 1 with radiotherapy, and 30 with surgery and radiation. Local disease control was 82.6% at 5 years. Recurrence was seen in 33% with local and regional disease recurrence at 15% and 18%, respectively. The 5- and 10-year overall survival rates were 87.9% and 69.2%, respectively. Dulguerov classification correlated most closely to survival and recurrence. CONCLUSIONS Dulguerov classification best correlates with the patient's outcome. A combined approach is the preferred treatment. It makes no difference whether radiotherapy is given pre or postsurgical resection. Recurrence can occur even 15 years after treatment. Therefore, long-term follow-up is essential.
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Affiliation(s)
- Gideon Bachar
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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Abstract
The sinonasal malignancies of putative neuroendocrine origin-esthesioneuroblastoma, sinonasal neuroendocrine carcinoma, sinonasal undifferentiated carcinoma, and sinonasal small cell carcinoma-are uncommon malignancies that frequently present with locally advanced disease. Pathologic distinction between these entities can be difficult, but is important to guide management. These malignancies require complex multimodality treatment and are best managed by multidisciplinary teams in major centers that have expertise in sinonasal malignancies.
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Affiliation(s)
- Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag No 1, A'Beckett Street, Melbourne 8006, Australia.
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