Sinonasal carcinoma with neuroendocrine differentiation: patterns of failure according to histologic phenotype

Rosenthal, David I.; Barker, Jerry L.; El‐Naggar, Adel K.; Glisson, Bonnie S.; Kies, Merrill S.; Dı́az, Eduardo; DeMonte, Franco; Selek, Uğur; Morrison, William; Ang, K. Kian; Garden, Adam S.

doi:10.1016/s0360-3016(03)01080-0

Cited by 62 publications

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“…1 These tumors occur with enough frequency that specific treatment strategies have emerged. [2][3][4][5] The nonsinonasal neuroendocrine carcinomas (NSNECs), however, are represented predominantly by small cell undifferentiated carcinomas, followed by moderately differentiated (atypical carcinoid) carcinomas and well-differentiated (typical carcinoid) carcinomas.…”

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confidence: 99%

Management of nonsinonasal neuroendocrine carcinomas of the head and neck

Barker¹,

Glisson²,

Garden³

et al. 2003

Cancer

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BACKGROUNDNonsinonasal neuroendocrine carcinomas (NSNEC) of the head and neck are rare and pose a diagnostic and management challenge. The authors undertook a retrospective study to gain insights into the spectrum of clinicopathologic characteristics, patterns of failure, and optimal management of patients with this disease.METHODSThe authors treated 23 adults with pathologically proven, nonmetastatic, primary NSNEC from 1984 to 2001. The majority (13 patients) had laryngeal origin with the following American Joint Committee on Cancer stage distribution: Stage I disease in 1 patient, Stage II disease in 2 patients, Stage III disease in 6 patients, and Stage IV disease in 14 patients. Nine patients underwent definitive surgery with or without postoperative radiation, and 14 patients received definitive radiotherapy. The median definitive radiation dose was 66 grays (Gy) (range, 44–72 Gy) using conventional fractionation. Fourteen patients received chemotherapy, with two to four cycles of induction platinum plus etoposide used most commonly.RESULTSThe median follow‐up time for surviving patients was 40 months (range, 15–89 months). The actuarial 2‐year and 5‐year overall survival (OS) rates were 53% and 33%, respectively; and the disease‐free survival (DFS) rates were 41% and 25%, respectively. Both the 2‐year OS rate (68% vs. 30%; P = 0.002) and the 2‐year DFS rate (55% vs. 17%; P = 0.004) were improved with chemotherapy compared with local therapy alone. Seventy‐five percent of patients with measurable disease had complete clinical responses to induction chemotherapy. There was 100% complete clinical response of tumor after radiotherapy. The actuarial 2‐year local failure rate was 23%. Chemotherapy did not reduce local failure (P = 0.91). There was no regional failure. The 2‐year and 5‐year distant metastasis rates were 54% and 71%, respectively. The 2‐year rates of metastases without and with chemotherapy were 79% and 39%, respectively (P = 0.006). The 2‐year and 5‐year rates of intracranial metastases were 25% and 44%, respectively, and the 2‐year and 5‐year rates of isolated brain metastases were 21% and 41%, respectively.CONCLUSIONSBased on these results, the authors' treatment strategy for patients with NSNEC is sequential chemotherapy and radiation. They recommend full‐dose radiotherapy alone for patients with NSNEC who achieve a complete clinical response to induction chemotherapy. Newer chemotherapeutic regimens or additional adjuvant chemotherapy should be investigated for patients with NSNEC given the high rate of distant failure. Due to the very high rate of brain metastases among patients in the current study, the authors now consider incorporating prophylactic cranial irradiation into primary radiotherapy for individual patients who have complete clinical responses to induction chemotherapy. Cancer 2003. © 2003 American Cancer Society.

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confidence: 99%

Management of nonsinonasal neuroendocrine carcinomas of the head and neck

Barker¹,

Glisson²,

Garden³

et al. 2003

Cancer

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“…McCluggage et al [6] described a sinonasal neuroendocrine carcinoma with exocrine and neuroendocrine differentiation or as the authors suggested, a ''goblet cell carcinoid'', a neoplasm significantly different from ''typical'' or ''atypical'' carcinoids tumors. More recently, Rosenthal et al [3] published a report of neuroendocrine tumors of the sinonasal tract and their patterns of failure according to histologic type. The series included 31 ONBs, 17 SCNECs, and 18 neuroendocrine carcinomas not otherwise specified.…”

Section: Discussionmentioning

confidence: 99%

“…One patient died of postoperative complications. Rosenthal et al [3] reported a 5-year overall survival rate of 64.2% for NSNECs with 72.6% local control rate, 12.9% regional failure rate and 14.1% distant metastasis rate. The overall survival rate, local control rate, regional failure rate, and distant metastasis rate of patients affected by NSNECs were poorer than those with ONB but significantly better than for those with SCNEC [3].…”

Section: Discussionmentioning

confidence: 99%

“…The 2005 World Health Organization Classification of Head and Neck Tumors categorizes these neoplasms as typical carcinoid tumor, atypical carcinoid tumor, small cell carcinoma neuroendocrine type (SCNEC), and neuroendocrine carcinoma ''not otherwise specified'' [1]. The most common and best studied of these neoplasms is SCNEC [2,3]; however, the pathological features of other types of sinonasal neuroendocrine carcinomas remain unclear and poorly defined [3][4][5][6][7][8]. To advance our understanding of sinonasal non-small cell neuroendocrine carcinoma (NSNEC), we describe the clinicopathologic features of two additional cases.…”

Section: Introductionmentioning

confidence: 99%

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Non-Small Cell Neuroendocrine Carcinoma of the Sinonasal Tract and Nasopharynx. Report of 2 Cases and Review of the Literature

Weinreb

Perez-Ordoñez

2007

Head and Neck Pathol

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Non-small cell neuroendocrine carcinomas (NSNECs) of the sinonasal tract are rare. Due to their rarity, the clinical and pathologic characteristics of these neoplasms are not adequately understood. We report two additional examples of NSNEC. The patients were male, 67-and 34-year-old. The first had a tumor involving left ethmoid sinus and nasal cavity and the second, a neoplasm involving nasopharynx, sphenoid sinus, with bilateral involvement of cavernous sinuses. Both tumors were composed of small to medium size cells showing round nuclei with finely dispersed chromatin and small to inconspicuous nucleoli. One case was characterized by variable size individual and confluent nests while the second demonstrated patternless sheets only. One case had punctate necrosis and a mitotic rate of 10-11/10 hpf whereas the second did not have necrosis and the mitotic rate was only 1-2/10 hpf. Both tumors were positive for keratins, CD56, and NSE. One case was positive for chromogranin and the second for synaptophysin. One patient is alive and free of disease 4 years after external beam radiotherapy. The second is alive with locally advanced disease 7 years after radiotherapy and chemotherapy. The literature suggests that NSNECs are a heterogenous group of neoplasms with a morphologic spectrum encompassing tumors resembling ''atypical carcinoids'', neoplasms composed of large cells akin to large cell neuroendocrine carcinomas, and tumors with glandular and goblet cell differentiation reminiscent of ''goblet cell carcinoids''. Other cases do not show specific features and are probably best regarded as ''neuroendocrine carcinoma, NOS''. More studies are needed to better define the histopathologic spectrum of these lesions and to develop a clinically relevant classification.

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“…The MD Anderson experience 11 shows the local control rate at 5 years was better for SNUC (78.6%) and NEC (72.6%) while it was 66.7% in SmCC. The regional failure (RF) rate at 5 years was 15.6% for patients with SNUC, 12.9% for patients with NEC, and 44.4% for patients with SmCC.…”

Section: Biology Of Tumoursmentioning

confidence: 99%

Endoscopic v/s conventional approach to sino-nasal tumours — What’s the debate?

Pai

Moiyadi

Nair

2010

Indian J Surg Oncol

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In the past two decades nasal endoscopy has advanced technologically to offer us magnified vision and better illumination along with better instrumentation. Surgery has traditionally been via the transfacial approaches such as lateral rhinotomy or the Weber Fergueson incision. For disease extension into the skull base traditional approach is a transfrontal craniotomy via either the bicoronal incision or the subcranial Raveh's approach. A combined access via the cranium from above and the transfacial access from below aids in encompassing the tumour all around. Transnasal access is a natural trajectory which leads us directly onto the tumour. The endoscope alone or with the microscope has been utilised to improve the magnification and illumination to aid in tumour removal. Minimal access to the Sinonasal and anterior skull base tumours is proven to be possible and feasible. We now have an additional armamentarium to our existing approaches in management of these tumours. We have to be judicious and see which approach can remove the disease completely maintaining the quality of life of the patient.

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Sinonasal carcinoma with neuroendocrine differentiation: patterns of failure according to histologic phenotype

Cited by 62 publications

References 0 publications

Management of nonsinonasal neuroendocrine carcinomas of the head and neck

Management of nonsinonasal neuroendocrine carcinomas of the head and neck

Non-Small Cell Neuroendocrine Carcinoma of the Sinonasal Tract and Nasopharynx. Report of 2 Cases and Review of the Literature

Endoscopic v/s conventional approach to sino-nasal tumours — What’s the debate?

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