Katano Atsuto, Minamitani Masanari, Ohira Shingo, Yamashita Hideomi
Department of Radiology, The University of Tokyo Hospital, Tokyo, JPN.
Department of Comprehensive Radiation Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, JPN.
Cureus. 2023 Oct 5;15(10):e46523. doi: 10.7759/cureus.46523. eCollection 2023 Oct.
Esthesioneuroblastoma (ENB), a rare malignancy arising from the olfactory epithelium, poses clinical challenges owing to its propensity for local invasion and recurrence. Its management typically involves surgical resection and adjuvant radiotherapy. However, debate persists regarding the optimal treatment strategy, particularly the use of elective nodal irradiation (ENI). This study aimed to investigate recurrence patterns in patients with localized ENB treated with surgery and adjuvant radiotherapy without ENI.
Our retrospective analysis included patients who underwent surgery followed by adjuvant radiotherapy for treatment of ENB between January 2011 and November 2022. Patients with incomplete data or who had received neoadjuvant radiotherapy were excluded. Patient characteristics, radiotherapy data (type, dose, and duration), and follow-up data were collected. Recurrence patterns were evaluated, and overall survival (OS), disease-free survival (DFS), and local control rates were determined using the Kaplan-Meier method.
Twelve patients with ENB (median age, 56 years) were included. Most had stage C disease. The median radiation dose was 60 Gy, and the median treatment duration was six weeks. Only one death was confirmed during the observation period, and the five-year DFS rates were 64.3%. Local control was achieved in 11 patients, with only one experiencing local recurrence. Regional lymph node recurrence occurred in three patients and was successfully managed via neck dissection. The timing of recurrence varied, emphasizing the importance of long-term surveillance.
Adjuvant radiotherapy without ENI is a viable treatment option for ENB, resulting in favorable local control and OS outcomes. Regional lymph node metastases were observed but effectively managed via salvage therapy. Prospective studies with larger cohorts are warranted to confirm the effectiveness of this treatment strategy and to define optimal radiotherapy fields.
嗅神经母细胞瘤（ENB）是一种起源于嗅上皮的罕见恶性肿瘤，因其易于局部侵犯和复发而带来临床挑战。其治疗通常包括手术切除和辅助放疗。然而，关于最佳治疗策略，尤其是选择性淋巴结照射（ENI）的使用，仍存在争议。本研究旨在调查接受手术和辅助放疗但未进行ENI的局限性ENB患者的复发模式。
我们的回顾性分析纳入了2011年1月至2022年11月期间接受手术及辅助放疗治疗ENB的患者。排除数据不完整或接受过新辅助放疗的患者。收集患者特征、放疗数据（类型、剂量和疗程）以及随访数据。评估复发模式，并使用Kaplan-Meier方法确定总生存期（OS）、无病生存期（DFS）和局部控制率。
纳入12例ENB患者（中位年龄56岁）。大多数为C期疾病。中位放疗剂量为60 Gy，中位治疗疗程为6周。观察期内仅确认1例死亡，5年DFS率为64.3%。11例患者实现局部控制，仅1例出现局部复发。3例患者发生区域淋巴结复发，通过颈部清扫成功处理。复发时间各不相同，强调了长期监测的重要性。
不进行ENI的辅助放疗是ENB的一种可行治疗选择，可带来良好的局部控制和OS结果。观察到区域淋巴结转移，但通过挽救性治疗有效处理。有必要开展更大队列的前瞻性研究，以证实该治疗策略的有效性并确定最佳放疗野。
