Utility of adjuvant chemotherapy in patients receiving surgery and adjuvant radiotherapy for primary treatment of esthesioneuroblastoma

Abstract

Background Past research established that surgery plus adjuvant radiotherapy (S + AR) improves overall survival (OS) in esthesioneuroblastoma (ENB). However, it is unknown if the addition of adjuvant chemotherapy (AC) further improves survival. The primary objective of this study was to compare survival among patients treated with S + AR alone to patients who underwent S + AR + AC. Methods Retrospective review of patient records. Results Thirty‐eight patients met inclusion criteria for either S + AR or S + AR + AC treatment groups. The S + AR + AC group contained more patients with Kadish stage D disease, dural invasion, and positive histologic margins postsurgery. All S + AR + AC patients received platinum‐based regimens, combined with etoposide in 67%. OS and recurrence‐free survival did not differ between the two groups, even when restricting the analysis to patients with Kadish stages B and C disease. Conclusion Patients who received platinum‐based AC did not exhibit improved survival compared to S + AR alone. Further investigation, preferably prospective, into the optimal use of systemic therapy in ENB is warranted.

Long-Term Survival Outcomes and Treatment Experience of 64 Patients With Esthesioneuroblastoma

“…The role of chemotherapy is still controversial in ENB, generally used for advanced, high-grade tumors (22)(23)(24). However, chemotherapy did not improve OS, RFS or DSS (25,26). In advanced tumors, we therefore support multimodal therapy.…”

Pattern of loco‐regional relapses and treatment in pediatric esthesioneuroblastoma: The French very rare tumors group (Fracture) contribution

“…The current treatment strategy in adults includes surgery followed by radiation therapy . Chemotherapy might be used in case of high‐grade, recurrent, or locoregionally advanced tumors . In pediatric cases, chemotherapy combined with surgery and radiotherapy (RT) is often the treatment of choice in advanced diseases compared to adult ones .…”

“…[12][13][14][15][16] Chemotherapy might be used in case of high-grade, recurrent, or locoregionally advanced tumors. [17][18][19] In pediatric cases, chemotherapy combined with surgery and radiotherapy (RT) is often the treatment of choice in advanced diseases compared to adult ones. 3,6 The incidence of cervical node metastases is about 10% at diagnosis but can increase to 20% during the disease in adults.…”

Induction Therapy Prior to Surgical Resection for Patients Presenting with Locally Advanced Esthesioneuroblastoma

“…While it is now established that surgery plus adjuvant radiotherapy is associated with superior survival in ENB, 2,5,6 there is still a question regarding the optimal use of chemotherapy after surgery. [7][8][9]21 Given that ENB can recur years after surgery, there is great interest in determining the optimal consolidation treatment that balances toxicity with efficacy to eradicate minimal residual disease. Further, there are biological characteristics of ENB, including tyrosine kinase mutations and BCL-2 dependency-which could be leveraged to develop more effective chemotherapy strategies in the future.…”

“…1,[4][5][6] Several studies have shown that ENB is sensitive to platinum-based chemotherapy, 7,8 but the impact of chemotherapy before and after surgery on overall survival (OS) for patients with localized disease is less clear. 1,8,9 Nonspecific symptomatology, such as nasal airway obstruction, anosmia, and epistaxis, frequently delays diagnosis in ENB. 10 Consequently, patients can present with locally advanced disease infiltrating the skull base that may appear unresectable on neuroimaging.…”