The role of elective nodal irradiation for esthesioneuroblastoma patients with clinically negative neck

Wen Jiang, Abdallah S.R. Mohamed, Clifton David Fuller, Betty Y.S. Kim, Chad Tang, G. Brandon Gunn, Ehab Y. Hanna, Steven J. Frank, Shirley Y. Su, Eduardo Diaz, Michael E. Kupferman, Beth M. Beadle, William H. Morrison, Heath Skinner, Stephen Y. Lai, Adel K. El-Naggar, Franco DeMonte, David I. Rosenthal, Adam S. Garden, Jack Phan

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)241-247
Number of pages7
JournalPractical Radiation Oncology
Volume6
Issue number4
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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    Jiang, W., Mohamed, A. S. R., Fuller, C. D., Kim, B. Y. S., Tang, C., Gunn, G. B., Hanna, E. Y., Frank, S. J., Su, S. Y., Diaz, E., Kupferman, M. E., Beadle, B. M., Morrison, W. H., Skinner, H., Lai, S. Y., El-Naggar, A. K., DeMonte, F., Rosenthal, D. I., Garden, A. S., & Phan, J. (2016). The role of elective nodal irradiation for esthesioneuroblastoma patients with clinically negative neck. Practical Radiation Oncology, 6(4), 241-247. https://doi.org/10.1016/j.prro.2015.10.023