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J Neurol Surg B Skull Base 2018; 79(03): 262-268
DOI: 10.1055/s-0037-1607298
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

Robbie S. R. Woods
1   Department of ENT Surgery, Beaumont Hospital, Dublin 9, Ireland
,
Thavakumar Subramaniam
1   Department of ENT Surgery, Beaumont Hospital, Dublin 9, Ireland
,
Mary Leader
2   Department of Histopathology, Beaumont Hospital, Dublin 9, Ireland
,
Rory McConn-Walsh
1   Department of ENT Surgery, Beaumont Hospital, Dublin 9, Ireland
,
James Paul O'Neill
1   Department of ENT Surgery, Beaumont Hospital, Dublin 9, Ireland
,
Peter D. Lacy
1   Department of ENT Surgery, Beaumont Hospital, Dublin 9, Ireland
› Author Affiliations
Further Information

Publication History

13 May 2017

05 September 2017

Publication Date:
01 November 2017 (online)

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Abstract

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.

Keywords

esthesioneuroblastoma - sinonasal malignancy - olfactory neuroblastoma - skull base

Note

This paper was presented at the American Head and Neck Society, 9th International Conference in Seattle, July 2016.


 

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