| Treatment and Prognosis for an Esthesioneuroblastoma over a 20-Year Period: Impact of Treatment Era |
| Chang Hoon Song, Il Han Kim, Hong Gyun Wu, Dong Wan Kim, Chae Seo Rhee |
1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ihkim@snu.ac.kr
2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
3Department of Otorhinolaryngology and Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.
4Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
5Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea. |
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| ABSTRACT |
PURPOSE:
To report on the changes in the patterns of care and survival over time for esthesioneuroblastoma.
MATERIALS AND METHODS:
We retrospectively analyzed 42 previously untreated and histologically confirmed esthesioneuroblastoma patients seen between March 1989 and June 2007. According to Kadish's classification, 3 patients (7%) were stage A, 6 (14%) at stage B, and 33 (79%) at stage C. Of the 33 Kadish C patients, 19 and 14 patients were treated from 1989 through 2000 and from 2001 through 2007, respectively.
Treatment included surgical resection, radiotherapy, chemotherapy, or a combination of these methods.
Chemotherapy was administered to 8 of 19 patients (42%) seen from 1989 through 2000, whereas all of the 14 patients seen from 2001 through 2007 received chemotherapy (p<0.001). No patient was treated by three-dimensional conformal radiotherapy (3D-CRT) from 1989 through 2000, however 8 of 14 patients (67%) seen from 2001 through 2007 underwent 3D-CRT (p<0.001). The median follow-up time for surviving patients was 6.5 years (range, 2.2~15.8 years).
RESULTS:
The 5-year overall survival (OS) and progression-free survival (PFS) rates for the entire cohort were 53% and 39%, respectively. The 5-year OS was 100% for Kadish stages A or B and 39% for stage C (p=0.007). For patients with stage C disease who were treated from 1989 to 2000 and from 2001 to 2007, the 5-year OS rate was 26% and 59% (p=0.029), respectively and the corresponding 5-year PFS rate was 16% and 46% (p=0.001), respectively. Intraorbital extension and treatment era (1989~2000 vs. 2001~2007) were found as independent factors for OS and PFS in a multivariate analyses.
CONCLUSION:
The results of this study suggest that treatment era, which features a distinction in treatment modality and technique with the introduction of 3D-CRT, may be the cause of improved OS and PFS in Kadish stage C patients. To achieve better outcomes for patients with Kadish stage C, combined chemoradiotherapy, especially 3D-CRT, is recommended in addition to surgery. |
| Key Words:
Esthesioneuroblastoma, Olfactory neuroblastoma, Radiotherapy, Chemotherapy |
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