Purpose/Objective(s): Esthesioneuroblastoma are uncommon tumors of the skull base best managed in a multidisciplinary setting with craniofacial resection (CFR) and adjuvant or neoadjuvant radiation therapy. In the era of Intensity-Modulated Radiation Therapy (IMRT), there is limited data to inform us of the safe and effective dose of radiation. The purpose of this study was to review our institutional experience with CFR and IMRT in the treatment of esthesioneuroblastoma.
Materials/Methods: We retrospectively reviewed the charts of patients with CFR and IMRT for ENB. Patient and physician-reported toxicity was scored and survival analyzed using the Kaplan-Meier method.
Results: Five patients were eligible for inclusion in our review. Disease was Kadish stage C in 60% (3) and B in 40% (2). Four patients underwent CFR followed by planned IMRT. Of these, 1 patient had gross positive margins and 3 had negative margins. One patient was unresectable at presentation and was treated neoadjuvantly with chemotherapy and IMRT, followed by CFR with clear margins. No patients had neck dissection. IMRT was delivered to the pre-operative tumor volume and surgical bed in 2 Gy fractions to a median dose of 60 Gy (range 58-64). Median follow-up for all patients was 32 months. There was one acute grade 3 cutaneous toxicity, and no other grade 3 or greater acute events. There was no grade 2 or greater late toxicity attributable to radiation therapy. One patient with Kadish C disease and gross residual disease after surgery developed parenchymal brain metastases distant to the tumor site that were noted 10 days after completion of IMRT. She died of disease 5 months after treatment. There were no other failures. 4-year actuarial overall survival was 75%; 4-year local control was 100%.
Conclusions: In this small series of patients, a median dose of 60 Gy to the tumor bed using IMRT was well tolerated with minimal acute toxicity and no significant late toxicity. This dose provided excellent local control in the setting of negative surgical margins. There were no failures in the cervical lymphatics, which were not electively treated.
Brown, L,
Esthesioneuroblastoma Treated with Craniofacial Resection and IMRT. Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL.
http://archive.rsna.org/2009/8502088.html
