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J Neurol Surg B Skull Base 2021; 82(S 03): e166-e171
DOI: 10.1055/s-0040-1708854
Original Article

Delaying Postoperative Radiotherapy in Low-Grade Esthesioneuroblastoma: Is It Worth the Wait?

Satoshi Kiyofuji 
1   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
2   Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan
,
Vijay Agarwal
1   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Joshua D. Hughes
1   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Robert L. Foote
3   Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States
,
Jeffrey R. Janus
4   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Eric J. Moore
4   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Caterina Giannini
5   Department of Pathology, Mayo Clinic, Rochester, Minnesota, United States
,
Michael J. Link
1   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
4   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Jamie J. Van Gompel 
1   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
4   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
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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.

Keywords

craniofacial resection - esthesioneuroblastoma - intensity-modulated radiation therapy - olfactory neuroblastoma - surgical treatment


Publication History

Received: 20 August 2019

Accepted: 14 February 2020

Article published online:
25 March 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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