Zamarud Aroosa, Yener Ulas, Sayed Rahman, Chang Steven D, Meola Antonio
Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA.
Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA.
Cureus. 2023 May 31;15(5):e39791. doi: 10.7759/cureus.39791. eCollection 2023 May.
Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare malignant tumor of neuroectodermal origin that arises from the olfactory epithelium. We present a case of ENB metastasizing through the leptomeningeal route to the spinal dura, which was treated with CyberKnife (CK) stereotactic radiosurgery (SRS), and aim to assess the safety and effectiveness of SRS in such cases. To the best of our knowledge, this is the first case report in the literature that discusses ENB spinal leptomeningeal metastases treated with CK radiosurgery. We retrospectively review the clinical and radiological outcomes in a 70-year-old female with ENB metastasis to the spine. Progression-free survival (PFS), overall survival (OS), and local tumor control (LTC) are investigated. In our patient, ENB had been diagnosed at the age of 58 years and spinal metastases had been first noted at the age of 65 years. A total of six spinal lesions received CK SRS. Lesions were present at the level of C1, C2, C3, C6-C7, T5, and T10-11. The median target volume was 0.72 cc (range: 0.32-2.54). A median marginal dose of 24 Gy was delivered to the tumors with a median of three fractions to a median isodose line of 80% (range: 78-81). LTC at the 24-month follow-up was 100%. PFS and OS were 27 months and 40 months, respectively. No adverse radiation effects were reported. Even though the treated spinal lesions remained stable, the number of new metastatic lesions had increased with progressive osseous and dural metastatic lesions within the cervical, thoracic, and lumbar spine at the last follow-up. SRS provides relatively good LTC for patients with ENB metastasizing to the spine, with no radiation-induced adverse events.
嗅神经母细胞瘤（ENB），也称为嗅觉神经母细胞瘤，是一种起源于神经外胚层的罕见恶性肿瘤，由嗅上皮发生。我们报告一例ENB经柔脑膜途径转移至硬脊膜的病例，该病例接受了射波刀（CK）立体定向放射外科治疗（SRS），旨在评估SRS在此类病例中的安全性和有效性。据我们所知，这是文献中首例讨论用CK放射外科治疗ENB脊柱柔脑膜转移的病例报告。我们回顾性分析了一名70岁女性ENB脊柱转移患者的临床和影像学结果。研究了无进展生存期（PFS）、总生存期（OS）和局部肿瘤控制（LTC）情况。在我们的患者中，ENB于58岁时确诊，脊柱转移首次发现于65岁。共有6个脊柱病灶接受了CK SRS治疗。病灶位于C1、C2、C3、C6 - C7、T5和T10 - 11水平。中位靶体积为0.72立方厘米（范围：0.32 - 2.54）。肿瘤的中位边缘剂量为24 Gy，分三次给予，中位等剂量线为80%（范围：78 - 81）。24个月随访时LTC为100%。PFS和OS分别为27个月和40个月。未报告有放疗不良反应。尽管治疗的脊柱病灶保持稳定，但在最后一次随访时，颈椎、胸椎和腰椎出现了新的骨和硬脊膜转移性病灶，且数量有所增加。SRS为ENB脊柱转移患者提供了相对较好的LTC，且无放疗引起的不良事件。
