Long-Term Tumor Control despite Late Pseudoprogression on(18)F-FDG-PET following Extremely Hypofractionated Stereotactic Radiotherapy for Retropharyngeal Lymph Node Metastasis from Esthesioneuroblastoma

Pseudoprogression Following Liver Stereotactic Body Radiotherapy (SBRT) in a Patient With Oligometastatic Leiomyosarcoma: A Case Report

Stereotactic body radiotherapy (SBRT) is a non-invasive form of radiation that has been utilized for oligometastatic malignancies. However, pseudoprogression is a common radiological occurrence following this treatment, which manifests as an increase in tumor size before its reduction. We discuss a case of a 58-year-old female patient who initially presented with uterine leiomyosarcoma. Following surgery and postoperative radiation, she was later found to have solitary liver metastasis after three years of surveillance, which was managed by SBRT. However, on short-term follow-up, the lesion was found to have increased in size, prompting discussion regarding whether the growth was a progression of disease or a secondary effect of treatment. After close follow-up, the tumor continued to shrink until it was no longer visible on imaging. This is the first report discussing pseudoprogression following SBRT in a retroperitoneal leiomyosarcoma patient. It serves as a reminder for clinicians to consider the possibility of pseudoprogression before the failure of therapy.

68Ga-DOTATOC PET/CT and MR in the Evaluation of Meningeal Metastasis From Esthesioneuroblastoma: A Case Report

ABSTRACT

Esthesioneuroblastoma is a rare malignant tumor arising from olfactory neuroepithelium. PET/CT with different tracers such as 18F-FDG and 68Ga-somatostatin-receptor tracers has demonstrated its utility for the evaluation of disease. We present the case of a woman previously treated for esthesioneuroblastoma performing MR and 18Ga-DOTATOC PET/CT demonstrating dural metastasis of disease with a strong correspondence between conventional and functional imaging.

Changing Trends in the Management of Esthesioneuroblastoma: Irish and International Perspectives

Objectives  Evaluation of the changing trends in esthesioneuroblastoma in an Irish context and review of management options nationally to clarify the best current therapeutic approach by comparing with international research on this uncommon malignancy. Design  Retrospective review. Setting  Tertiary referral center. Participants  All patients presenting with esthesioneuroblastoma in Beaumont hospital or on the National Cancer Registry of Ireland between 1994 and 2013. Main Outcome Measures  Recurrence-free and overall survival. Results  During the study period, 32 cases of esthesioneuroblastoma were diagnosed (0.4 per million per year). Average age at diagnosis was 57 years; however, two cases were under 20. The majority (62.5%) were male. Patients predominantly presented with epistaxis or nasal congestion (73%), while two cases were identified incidentally on radiological investigations. Twenty-seven cases underwent primary surgical management (two post neo-adjuvant treatment) with seventeen requiring bifrontal craniotomy. Twenty-four of these received postoperative radiation therapy. Overall, 5-year survival was 65%. Kadish A/B patients exhibited 100% 5-year disease-specific survival versus 54% in Kadish C/D ( p  = 0.011). Hyams grade I/II patients exhibited 75% 5-year disease-specific survival versus 63% in Hyams grade III/IV ( p  = 0.005). Patients treated endoscopically exhibited 100% 5-year disease-specific survival versus 51% in those treated via an open approach ( p  = 0.102). Conclusions  Many controversies exist in the diagnosis and management of this condition. Despite this, results from Irish data are mostly concordant with the international literature. The rising incidence of this disease may represent improved pathological recognition. An increasing number of esthesioneuroblastoma cases are being successfully treated via endoscopic surgery.