Esthesioneuroblastoma: is there a need for elective neck treatment?

Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e255-61. doi: 10.1016/j.ijrobp.2011.03.036. Epub 2011 Jun 15.


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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Disease-Free Survival
  • Esthesioneuroblastoma, Olfactory / mortality
  • Esthesioneuroblastoma, Olfactory / pathology
  • Esthesioneuroblastoma, Olfactory / radiotherapy*
  • Esthesioneuroblastoma, Olfactory / secondary
  • Esthesioneuroblastoma, Olfactory / surgery*
  • Female
  • Humans
  • Lymphatic Irradiation / methods*
  • Lymphatic Irradiation / mortality
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Nasal Cavity*
  • Neck
  • Nose Neoplasms / mortality
  • Nose Neoplasms / pathology
  • Nose Neoplasms / radiotherapy*
  • Nose Neoplasms / surgery*
  • Retrospective Studies
  • Salvage Therapy / methods
  • Salvage Therapy / mortality
  • Young Adult