Mitchell R Gore1, Adam M Zanation. 1. Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7070, USA.
Abstract
OBJECTIVE: Esthesioneuroblastoma (ENB) is an uncommon tumor of the sinonasal region with a 20% rate of neck metastases. To our knowledge, the rate of neck metastases occurring 6 or more months after diagnosis has not been well characterized. The rate of successful salvage of these late neck metastases, defined in this study as disease-free survival for at least 1 year, has not been previously reported. DESIGN: Meta-analysis examining 33 articles published since 1990. PATIENTS: A total of 678 patients with ENB with 79 patients with neck metastases occurring 6 or more months after the initial diagnosis. INTERVENTIONS: Patients were grouped according to treatment with surgery, radiotherapy, or combined surgery and radiotherapy. MAIN OUTCOME MEASURES: The rate of successful salvage of late neck metastases, defined as disease-free survival for at least 1 year, was compared for the 3 treatment groups. RESULTS: The rate of cervical metastases was 20.2%, with a 12.4% rate of late neck metastases. The combined successful salvage rate for late neck metastases with surgery, radiation, or combined therapy was 31.2%. An odds ratio (OR) analysis revealed that surgery plus radiation provided a statistically significant increase in the rate of successful salvage in patients with late neck metastases, with an OR of 8.6 vs single modality therapy and a number-needed-to-treat of 3. We found no difference in the OR for successful salvage for surgery alone vs radiation alone (OR, 1.5). CONCLUSION: Treatment of neck metastases occurring 6 or more months after an initial diagnosis of ENB with combined surgery and radiotherapy provides a statistically significant survival advantage vs single-modality therapy.
OBJECTIVE: Esthesioneuroblastoma (ENB) is an uncommon tumor of the sinonasal region with a 20% rate of neck metastases. To our knowledge, the rate of neck metastases occurring 6 or more months after diagnosis has not been well characterized. The rate of successful salvage of these late neck metastases, defined in this study as disease-free survival for at least 1 year, has not been previously reported. DESIGN: Meta-analysis examining 33 articles published since 1990. PATIENTS: A total of 678 patients with ENB with 79 patients with neck metastases occurring 6 or more months after the initial diagnosis. INTERVENTIONS:Patients were grouped according to treatment with surgery, radiotherapy, or combined surgery and radiotherapy. MAIN OUTCOME MEASURES: The rate of successful salvage of late neck metastases, defined as disease-free survival for at least 1 year, was compared for the 3 treatment groups. RESULTS: The rate of cervical metastases was 20.2%, with a 12.4% rate of late neck metastases. The combined successful salvage rate for late neck metastases with surgery, radiation, or combined therapy was 31.2%. An odds ratio (OR) analysis revealed that surgery plus radiation provided a statistically significant increase in the rate of successful salvage in patients with late neck metastases, with an OR of 8.6 vs single modality therapy and a number-needed-to-treat of 3. We found no difference in the OR for successful salvage for surgery alone vs radiation alone (OR, 1.5). CONCLUSION: Treatment of neck metastases occurring 6 or more months after an initial diagnosis of ENB with combined surgery and radiotherapy provides a statistically significant survival advantage vs single-modality therapy.
Authors: Justin G Peacock; William S Harmsen; Michael J Link; Jamie J Van Gompel; Caterina Giannini; Kerry D Olsen; Yolanda I Garces; Michelle A Neben Wittich; Daniel J Ma; Sean S Park; Robert L Foote Journal: J Neurol Surg B Skull Base Date: 2016-07-06
Authors: Adam M Zanation; Alfio Ferlito; Alessandra Rinaldo; Mitchell R Gore; Valerie J Lund; Kibwei A McKinney; Carlos Suárez; Robert P Takes; Anand K Devaiah Journal: Eur Arch Otorhinolaryngol Date: 2010-08-13 Impact factor: 2.503
Authors: Robbie S R Woods; Thavakumar Subramaniam; Mary Leader; Rory McConn-Walsh; James Paul O'Neill; Peter D Lacy Journal: J Neurol Surg B Skull Base Date: 2017-11-01