Craniofacial Surgery for Esthesioneuroblastoma: Report of an International Collaborative Study

Abstract

Introduction Impact of treatment and prognostic indicators of outcome are relatively ill-defined in esthesioneuroblastomas (ENB) because of the rarity of these tumors. This study was undertaken to assess the impact of craniofacial resection (CFR) on outcome of ENB.

Patients and Methods Data on 151 patients who underwent CFR for ENB were collected from 17 institutions that participated in an international collaborative study. Patient, tumor, treatment, and outcome data were collected by questionnaires and variables were analyzed for prognostic impact on overall, disease-specific and recurrence-free survival. The majority of tumors were staged Kadish stage C (116 or 77%). Overall, 90 patients (60%) had received treatment before CFR, radiation therapy in 51 (34%), and chemotherapy in 23 (15%). The margins of surgical resection were reported positive in 23 (15%) patients. Adjuvant postoperative radiation therapy was used in 51 (34%) and chemotherapy in 9 (6%) patients.

Results Treatment-related complications were reported in 49 (32%) patients. With a median follow-up of 56 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 78, 83, and 64%, respectively. Intracranial extension of the disease and positive surgical margins were independent predictors of worse overall, disease-specific, and recurrence-free survival on multivariate analysis.

Conclusion This collaborative study of patients treated at various institutions across the world demonstrates the efficacy of CFR for ENB. Intracranial extension of disease and complete surgical excision were independent prognostic predictors of outcome.

Keywords

nose neoplasms/mortality/pathology/surgery/*therapy - esthesioneuroblastoma - olfactory/*therapy - combined modality therapy - radiotherapy - adjuvant - survival analysis

• References

• 1 Broich G, Pagliari A, Ottaviani F. Esthesioneuroblastoma: a general review of the cases published since the discovery of the tumour in 1924. Anticancer Res 1997; 17 (4A) 2683-2706
• 2 Dulguerov P, Allal AS, Calcaterra TC. Esthesioneuroblastoma: a meta-analysis and review. Lancet Oncol 2001; 2 (11) 683-690
• 3 Ejaz A, Wenig BM. Sinonasal undifferentiated carcinoma: clinical and pathologic features and a discussion on classification, cellular differentiation, and differential diagnosis. Adv Anat Pathol 2005; 12 (3) 134-143
• 4 Rosenthal DI, Barker Jr JL, El-Naggar AK , et al. Sinonasal malignancies with neuroendocrine differentiation: patterns of failure according to histologic phenotype. Cancer 2004; 101 (11) 2567-2573
• 5 Cohen ZR, Marmor E, Fuller GN, DeMonte F. Misdiagnosis of olfactory neuroblastoma. Neurosurg Focus 2002; 12 (5) e3
• 6 Resto VA, Eisele DW, Forastiere A, Zahurak M, Lee DJ, Westra WH. Esthesioneuroblastoma: the Johns Hopkins experience. Head Neck 2000; 22 (6) 550-558
• 7 Cantrell RW, Ghorayeb BY, Fitz-Hugh GS. Esthesioneuroblastoma: diagnosis and treatment. Ann Otol Rhinol Laryngol 1977; 86 (6 Pt 1) 760-765
• 8 Levine PA, McLean WC, Cantrell RW. Esthesioneuroblastoma: the University of Virginia experience 1960–1985. Laryngoscope 1986; 96 (7) 742-746
• 9 Patel SG, Singh B, Polluri A , et al. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer 2003; 98 (6) 1179-1187
• 10 Hyams VJ. Tumors of the Upper Respiratory Tract and Ear. Washington, DC: Armed Forces Institute of Pathology; 1988
• 11 Morita A, Ebersold MJ, Olsen KD, Foote RL, Lewis JE, Quast LM. Esthesioneuroblastoma: prognosis and management. Neurosurgery 1993; 32 (5) 706-714 , discussion 714–715
• 12 Miyamoto RC, Gleich LL, Biddinger PW, Gluckman JL. Esthesioneuroblastoma and sinonasal undifferentiated carcinoma: impact of histological grading and clinical staging on survival and prognosis. Laryngoscope 2000; 110 (8) 1262-1265
• 13 Dias FL, Sa GM, Lima RA , et al. Patterns of failure and outcome in esthesioneuroblastoma. Arch Otolaryngol Head Neck Surg 2003; 129 (11) 1186-1192
• 14 Barnes L, Thompson LDR. Head and Neck Pathology. 69th Annual Anatomic Pathology Slide Seminar of the American Society for Clinical Pathology;. New Orleans, LA: 2003
• 15 Argani P, Perez-Ordoñez B, Xiao H, Caruana SM, Huvos AG, Ladanyi M. Olfactory neuroblastoma is not related to the Ewing family of tumors: absence of EWS/FLI1 gene fusion and MIC2 expression. Am J Surg Pathol 1998; 22 (4) 391-398
• 16 Carney ME, O'Reilly RC, Sholevar B , et al. Expression of the human Achaete-scute 1 gene in olfactory neuroblastoma (esthesioneuroblastoma). J Neurooncol 1995; 26 (1) 35-43
• 17 Shida T, Furuya M, Nikaido T , et al. Aberrant expression of human achaete-scute homologue gene 1 in the gastrointestinal neuroendocrine carcinomas. Clin Cancer Res 2005; 11 (2 Pt 1) 450-458
• 18 Mhawech P, Berczy M, Assaly M , et al. Human achaete-scute homologue (hASH1) mRNA level as a diagnostic marker to distinguish esthesioneuroblastoma from poorly differentiated tumors arising in the sinonasal tract. Am J Clin Pathol 2004; 122 (1) 100-105
• 19 Kadish S, Goodman M, Wang CC. Olfactory neuroblastoma. A clinical analysis of 17 cases. Cancer 1976; 37 (3) 1571-1576
• 20 Silva EG, Butler JJ, Mackay B, Goepfert H. Neuroblastomas and neuroendocrine carcinomas of the nasal cavity: a proposed new classification. Cancer 1982; 50 (11) 2388-2405
• 21 Dulguerov P, Calcaterra T. Esthesioneuroblastoma: the UCLA experience 1970–1990. Laryngoscope 1992; 102 (8) 843-849
• 22 Biller HF, Lawson W, Sachdev VP, Som P. Esthesioneuroblastoma: surgical treatment without radiation. Laryngoscope 1990; 100 (11) 1199-1201
• 23 Cantù G, Solero CL, Mariani L , et al. Anterior craniofacial resection for malignant ethmoid tumors—a series of 91 patients. Head Neck 1999; 21 (3) 185-191
• 24 McCary WS, Levine PA, Cantrell RW. Preservation of the eye in the treatment of sinonasal malignant neoplasms with orbital involvement. A confirmation of the original treatise. Arch Otolaryngol Head Neck Surg 1996; 122 (6) 657-659
• 25 Tiwari R, van der Wal J, van der Waal I, Snow G. Studies of the anatomy and pathology of the orbit in carcinoma of the maxillary sinus and their impact on preservation of the eye in maxillectomy. Head Neck 1998; 20 (3) 193-196
• 26 Imola MJ, Schramm Jr VL. Orbital preservation in surgical management of sinonasal malignancy. Laryngoscope 2002; 112 (8 Pt 1) 1357-1365
• 27 Andersen PE, Kraus DH, Arbit E, Shah JP. Management of the orbit during anterior fossa craniofacial resection. Arch Otolaryngol Head Neck Surg 1996; 122 (12) 1305-1307
• 28 Iannetti G, Valentini V, Rinna C, Ventucci E, Marianetti TM. Ethmoido-orbital tumors: our experience. J Craniofac Surg 2005; 16 (6) 1085-1091
• 29 Ganly I, Patel SG, Singh B , et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 2005; 27 (6) 445-451
• 30 Irish J, Dasgupta R, Freeman J , et al. Outcome and analysis of the surgical management of esthesioneuroblastoma. J Otolaryngol 1997; 26 (1) 1-7
• 31 Solero CL, DiMeco F, Sampath P , et al. Combined anterior craniofacial resection for tumors involving the cribriform plate: early postoperative complications and technical considerations. Neurosurgery 2000; 47 (6) 1296-1304 , discussion 1304–1305
• 32 Levine PA, Gallagher R, Cantrell RW. Esthesioneuroblastoma: reflections of a 21-year experience. Laryngoscope 1999; 109 (10) 1539-1543
• 33 Monroe AT, Hinerman RW, Amdur RJ, Morris CG, Mendenhall WM. Radiation therapy for esthesioneuroblastoma: rationale for elective neck irradiation. Head Neck 2003; 25 (7) 529-534
• 34 Eich HT, Staar S, Micke O, Eich PD, Stützer H, Müller R. Radiotherapy of esthesioneuroblastoma. Int J Radiat Oncol Biol Phys 2001; 49 (1) 155-160
• 35 Gruber G, Laedrach K, Baumert B, Caversaccio M, Raveh J, Greiner R. Esthesioneuroblastoma: irradiation alone and surgery alone are not enough. Int J Radiat Oncol Biol Phys 2002; 54 (2) 486-491
• 36 Polonowski JM, Brasnu D, Roux FX, Bassot V. Esthesioneuroblastoma. Complete tumor response after induction chemotherapy. Ear Nose Throat J 1990; 69 (11) 743-746
• 37 McElroy Jr EA, Buckner JC, Lewis JE. Chemotherapy for advanced esthesioneuroblastoma: the Mayo Clinic experience. Neurosurgery 1998; 42 (5) 1023-1027 , discussion 1027–1028
• 38 Polin RS, Sheehan JP, Chenelle AG , et al. The role of preoperative adjuvant treatment in the management of esthesioneuroblastoma: the University of Virginia experience. Neurosurgery 1998; 42 (5) 1029-1037
• 39 Sheehan JM, Sheehan JP, Jane Sr JA, Polin RS. Chemotherapy for esthesioneuroblastomas. Neurosurg Clin N Am 2000; 11 (4) 693-701
• 40 Oskouian Jr RJ, Jane Sr JA, Dumont AS, Sheehan JM, Laurent JJ, Levine PA. Esthesioneuroblastoma: clinical presentation, radiological, and pathological features, treatment, review of the literature, and the University of Virginia experience. Neurosurg Focus 2002; 12 (5) e4
• 41 Rinaldo A, Ferlito A, Shaha AR, Wei WI, Lund VJ. Esthesioneuroblastoma and cervical lymph node metastases: clinical and therapeutic implications. Acta Otolaryngol 2002; 122 (2) 215-221
• 42 Foote RL, Morita A, Ebersold MJ , et al. Esthesioneuroblastoma: the role of adjuvant radiation therapy. Int J Radiat Oncol Biol Phys 1993; 27 (4) 835-842
• 43 Diaz Jr EM, Johnigan III RH, Pero C , et al. Olfactory neuroblastoma: the 22-year experience at one comprehensive cancer center. Head Neck 2005; 27 (2) 138-149
• 44 Elkon D, Hightower SI, Lim ML, Cantrell RW, Constable WC. Esthesioneuroblastoma. Cancer 1979; 44 (3) 1087-1094
• 45 Beitler JJ, Fass DE, Brenner HA , et al. Esthesioneuroblastoma: is there a role for elective neck treatment?. Head Neck 1991; 13 (4) 321-326
• 46 Davis RE, Weissler MC. Esthesioneuroblastoma and neck metastasis. Head Neck 1992; 14 (6) 477-482