Xinmao Song1, Chuang Huang2, Shengzi Wang3, Li Yan1, Jie Wang4, Yi Li5. 1. Department of Radiation Oncology, Eye, Ear, Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China. 2. Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, 181 Hanyu Road, Chongqing 400030, China. 3. Department of Radiation Oncology, Eye, Ear, Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China. Electronic address: shengziwang@126.com. 4. Department of E.N.T., Eye, Ear, Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China. 5. Department of Oncology, 920(th) Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming 650032, China. Electronic address: liyi3443@hotmail.com.
Abstract
OBJECTIVE: Optimal neck management in patients with olfactory neuroblastoma (ONB), a rare malignancy, remains uncertain. This study aimed to analyse patterns of cervical lymph node metastases and corresponding clinical outcomes and to investigate the value of elective neck irradiation (ENI) in this population. METHODS AND MATERIALS: This study retrospectively reviewed clinical records, imaging findings, nodal metastasis features and treatment data of 217 patients with ONB treated at our hospital during 1991-2019. Univariate and multivariate analyses were used to assess the influence of cervical lymph node involvement on treatment outcomes. Survival and regional failure rates were compared between patients with or without ENI. RESULTS: Thirty-two patients (14.7%) presented initially with cervical lymph node metastases, most frequently at levels II (10.6%, 23/217) and VIIa (5.5%, 12/217). Patients with and without cervical node metastasis differed significantly in overall (OS) (41.9% vs. 86.1%, p < 0.001), progression-free (PFS) (41.9% vs. 84.8%, p < 0.001), regional failure-free (45.9% vs. 89%, p < 0.001) and distant metastasis-free survival (41.5% vs. 86.1%, p < 0.001). Cervical lymph involvement was an independent factor affecting poor OS (hazard ratio, 0.184, 95% confidence interval, 0.078-0.436, p < 0.001) and PFS (hazard ratio, 0.198, 95% confidence interval, 0.088-0.445, p < 0.001). Moreover, 43.8% patients (95/217) underwent ENI, which significantly reduced the incidence of regional recurrence from 10.7% to 3.2% (χ2 = 4.396, p = 0.036) but did not significantly affect other survival outcomes. Regional failures could be resolved using salvage treatment. CONCLUSIONS: Our findings indicate the importance of systematic therapy for patients with initial cervical lymph node metastases. ENI is not recommended for N0 disease.
OBJECTIVE: Optimal neck management in patients with olfactory neuroblastoma (ONB), a rare malignancy, remains uncertain. This study aimed to analyse patterns of cervical lymph node metastases and corresponding clinical outcomes and to investigate the value of elective neck irradiation (ENI) in this population. METHODS AND MATERIALS: This study retrospectively reviewed clinical records, imaging findings, nodal metastasis features and treatment data of 217 patients with ONB treated at our hospital during 1991-2019. Univariate and multivariate analyses were used to assess the influence of cervical lymph node involvement on treatment outcomes. Survival and regional failure rates were compared between patients with or without ENI. RESULTS: Thirty-two patients (14.7%) presented initially with cervical lymph node metastases, most frequently at levels II (10.6%, 23/217) and VIIa (5.5%, 12/217). Patients with and without cervical node metastasis differed significantly in overall (OS) (41.9% vs. 86.1%, p < 0.001), progression-free (PFS) (41.9% vs. 84.8%, p < 0.001), regional failure-free (45.9% vs. 89%, p < 0.001) and distant metastasis-free survival (41.5% vs. 86.1%, p < 0.001). Cervical lymph involvement was an independent factor affecting poor OS (hazard ratio, 0.184, 95% confidence interval, 0.078-0.436, p < 0.001) and PFS (hazard ratio, 0.198, 95% confidence interval, 0.088-0.445, p < 0.001). Moreover, 43.8% patients (95/217) underwent ENI, which significantly reduced the incidence of regional recurrence from 10.7% to 3.2% (χ2 = 4.396, p = 0.036) but did not significantly affect other survival outcomes. Regional failures could be resolved using salvage treatment. CONCLUSIONS: Our findings indicate the importance of systematic therapy for patients with initial cervical lymph node metastases. ENI is not recommended for N0 disease.
Authors: Matt Lechner; Yoko Takahashi; Mario Turri-Zanoni; Jacklyn Liu; Nicholas Counsell; Mario Hermsen; Raman Preet Kaur; Tianna Zhao; Murugappan Ramanathan; Volker H Schartinger; Oscar Emanuel; Sam Helman; Jordan Varghese; Jozsef Dudas; Herbert Riechelmann; Susanne Sprung; Johannes Haybaeck; David Howard; Nils Wolfgang Engel; Sarah Stewart; Laura Brooks; Jessica C Pickles; Thomas S Jacques; Tim R Fenton; Luke Williams; Francis M Vaz; Paul O'Flynn; Paul Stimpson; Simon Wang; S Alam Hannan; Samit Unadkat; Jonathan Hughes; Raghav Dwivedi; Cillian T Forde; Premjit Randhawa; Simon Gane; Jonathan Joseph; Peter J Andrews; Gary Royle; Alessandro Franchi; Roberta Maragliano; Simonetta Battocchio; Helen Bewicke-Copley; Christodoulos Pipinikas; Amy Webster; Chrissie Thirlwell; Debbie Ho; Andrew Teschendorff; Tianyu Zhu; Christopher D Steele; Nischalan Pillay; Bart Vanhaesebroeck; Ahmed Mohyeldin; Juan Fernandez-Miranda; Ki Wan Park; Quynh-Thu Le; Robert B West; Rami Saade; R Peter Manes; Sacit Bulent Omay; Eugenia M Vining; Benjamin L Judson; Wendell G Yarbrough; Maddalena Sansovini; Nicolini Silvia; Ilaria Grassi; Alberto Bongiovanni; David Capper; Ulrich Schüller; Selvam Thavaraj; Ann Sandison; Pavol Surda; Claire Hopkins; Marco Ferrari; Davide Mattavelli; Vittorio Rampinelli; Fabio Facchetti; Piero Nicolai; Paolo Bossi; Oswaldo A Henriquez; Kelly Magliocca; C Arturo Solares; Sarah K Wise; Jose L Llorente; Zara M Patel; Jayakar V Nayak; Peter H Hwang; Peter D Lacy; Robbie Woods; James P O'Neill; Amrita Jay; Dawn Carnell; Martin D Forster; Masaru Ishii; Nyall R London; Diana M Bell; Gary L Gallia; Paolo Castelnuovo; Stefano Severi; Valerie J Lund; Ehab Y Hanna Journal: Eur J Cancer Date: 2021-12-31 Impact factor: 10.002
Authors: J D Palmer; M E Gamez; K Ranta; H Ruiz-Garcia; J L Peterson; D M Blakaj; D Prevedello; R Carrau; A Mahajan; K L Chaichana; D M Trifiletti Journal: J Neurooncol Date: 2020-08-12 Impact factor: 4.130