TY - JOUR
T1 - The role of elective nodal irradiation for esthesioneuroblastoma patients with clinically negative neck
AU - Jiang, Wen
AU - Mohamed, Abdallah S.R.
AU - Fuller, Clifton David
AU - Kim, Betty Y.S.
AU - Tang, Chad
AU - Gunn, G. Brandon
AU - Hanna, Ehab Y.
AU - Frank, Steven J.
AU - Su, Shirley Y.
AU - Diaz, Eduardo
AU - Kupferman, Michael E.
AU - Beadle, Beth M.
AU - Morrison, William H.
AU - Skinner, Heath
AU - Lai, Stephen Y.
AU - El-Naggar, Adel K.
AU - DeMonte, Franco
AU - Rosenthal, David I.
AU - Garden, Adam S.
AU - Phan, Jack
N1 - Publisher Copyright:
© 2016 American Society for Radiation Oncology.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Purpose: Although adjuvant radiation to the tumor bed has been reported to improve the clinic outcomes of esthesioneuroblastoma (ENB) patients, the role of elective neck irradiation (ENI) in clinically node-negative (N0) patients remains controversial. Here, we evaluated the effects of ENI on neck nodal relapse risk in ENB patients treated with radiation therapy as a component of multimodality treatment. Methods and materials: Seventy-one N0 ENB patients irradiated at the University of Texas MD Anderson Cancer Center between 1970 and 2013 were identified. ENI was performed on 22 of these patients (31%). Survival analysis was performed with focus on comparative outcomes of those patients who did and did not receive ENI. Results: The median follow-up time for our cohort is 80.8 months (range, 6-350 months). Among N0 patients, 13 (18.3%) developed neck nodal relapses, with a median time to progression of 62.5 months. None of these 13 patients received prophylactic neck irradiation. ENI was associated with significantly improved regional nodal control at 5 years (regional control rate of 100% for ENI vs 82%, P < .001), but not overall survival or disease-free survival. Eleven patients without ENI developed isolated neck recurrences. All had further treatment for their neck disease, including neck dissection (n = 10), radiation (n = 10), or chemotherapy (n = 5). Six of these 11 patients (54.5%) demonstrated no evidence of further recurrence with a median follow-up of 55.5 months. Conclusion: ENI significantly reduces the risk of cervical nodal recurrence in ENB patients with clinically N0 neck, but this did not translate to a survival benefit. Multimodality treatment for isolated neck recurrence provides a reasonable salvage rate. The greatest benefit for ENI appeared to be among younger patients who presented with Kadish C disease. Further studies are needed to confirm these findings.
AB - Purpose: Although adjuvant radiation to the tumor bed has been reported to improve the clinic outcomes of esthesioneuroblastoma (ENB) patients, the role of elective neck irradiation (ENI) in clinically node-negative (N0) patients remains controversial. Here, we evaluated the effects of ENI on neck nodal relapse risk in ENB patients treated with radiation therapy as a component of multimodality treatment. Methods and materials: Seventy-one N0 ENB patients irradiated at the University of Texas MD Anderson Cancer Center between 1970 and 2013 were identified. ENI was performed on 22 of these patients (31%). Survival analysis was performed with focus on comparative outcomes of those patients who did and did not receive ENI. Results: The median follow-up time for our cohort is 80.8 months (range, 6-350 months). Among N0 patients, 13 (18.3%) developed neck nodal relapses, with a median time to progression of 62.5 months. None of these 13 patients received prophylactic neck irradiation. ENI was associated with significantly improved regional nodal control at 5 years (regional control rate of 100% for ENI vs 82%, P < .001), but not overall survival or disease-free survival. Eleven patients without ENI developed isolated neck recurrences. All had further treatment for their neck disease, including neck dissection (n = 10), radiation (n = 10), or chemotherapy (n = 5). Six of these 11 patients (54.5%) demonstrated no evidence of further recurrence with a median follow-up of 55.5 months. Conclusion: ENI significantly reduces the risk of cervical nodal recurrence in ENB patients with clinically N0 neck, but this did not translate to a survival benefit. Multimodality treatment for isolated neck recurrence provides a reasonable salvage rate. The greatest benefit for ENI appeared to be among younger patients who presented with Kadish C disease. Further studies are needed to confirm these findings.
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U2 - 10.1016/j.prro.2015.10.023
DO - 10.1016/j.prro.2015.10.023
M3 - Article
C2 - 26979544
AN - SCOPUS:84960157110
SN - 1879-8500
VL - 6
SP - 241
EP - 247
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
IS - 4
ER -