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Successful Treatment of Esthesioneuroblastoma and Neuroendocrine Carcinoma With Combined Chemotherapy and Proton Radiation: Results in 9 Cases

Successful Treatment of Esthesioneuroblastoma and Neuroendocrine Carcinoma With Combined... Abstract Objective: To study the efficacy of a newly designed treatment strategy for esthesioneuroblastoma and neuroendocrine carcinoma of the paranasal sinuses. Design and Setting: Nonrandomized prospective study of a case series in a tertiary referral center. Patients: Nine consecutive patients with newly diagnosed esthesioneuroblastoma or neuroendocrine carcinoma of the paranasal sinuses from June 1992 to October 1995 underwent this treatment protocol. Interventions: After histological diagnosis and detailed imaging, 2 cycles of cisplatin and etoposide chemotherapy were instituted. Chemotherapy responders were treated with combined photon and stereotaxic fractionated proton radiation therapy totaling approximately 68 Gy to the primary site, whereas poor responders were treated with surgical resection followed by postoperative radiation. In both cases, therapy was then concluded with 2 additional cycles of cisplatin and etoposide chemotherapy. Main Outcomes Measures: Response to therapy, survival, disease-free survival, and complications of therapy were examined. Results: Nine patients with a median Dulguerov T stage of T3 (range, T2 to T4) completed the treatment protocol, with mean follow-up after diagnosis of 20.5 months. Eight of 9 patients exhibited a dramatic response to therapy with remission of their tumor, and resection was not required. One patient failed to respond to induction chemotherapy and received surgical therapy to be followed by postoperative radiotherapy. There have been no recurrences (mean disease-free interval of 14.0 months). Complications were limited and generally transient. Conclusions: The use of combined cisplatin and etoposide chemotherapy with proton radiation has demonstrated initial success in treatment of these tumors. Dramatic response from chemotherapy is possible even in bulky or unresectable disease. This protocol has an acceptable complication rate and conveys less morbidity than craniofacial resection and conventional radiotherapy. Further follow-up will be required to determine the long-term success rate of this therapeutic protocol.Arch Otolaryngol Head Neck Surg. 1997;123:34-40 References 1. Morita A, Ebersold MJ, Olsen KD, Foote RL, Lewis JE, Quast LM. Esthesioneuroblastoma: prognosis and management . Neurosurgery . 1993;32:706-715.Crossref 2. Berger L, Luc R. L'esthesioneuroepitheliome olfactif . Bull Assoc Fr Etude Cancer . 1924;13:410-421. 3. Hyams VJ. Tumors of the upper respiratory tract and ear . In: Hyams VJ, Batsakis JG, Michaels L, eds. Atlas of Tumor Pathology . Washington, DC: Armed Forces Institute of Pathology; 1988:240-248. Second series, (pt 25) . 4. Kadish S, Goodman M, Wang CC. Olfactory neuroblastoma: a clinical analysis of 17 cases . Cancer . 1976;37:1571-1576.Crossref 5. Lund VJ, Milroy C. Olfactory neuroblastoma: clinical and pathological aspects . Rhinology . 1993;31:1-6. 6. Elkon D, Hightower SI, Lim ML, Cantrell RW, Constable WC. Esthesioneuroblastoma . Cancer . 1979;44:1087-1094.Crossref 7. Biller HF, Lawson W, Sachdev VP, Som P. Esthesioneuroblastoma: surgical treatment without radiation . Laryngoscope . 1990;100:1199-1201.Crossref 8. Levine PA, McClean WC, Cantrell RW. Esthesioneuroblastoma: the University of Virginia experience: 1960-1985 . Laryngoscope . 1986;96:742-746. 9. Wade PM Jr, Smith RE, Johns ME. Response of esthesioneuroblastoma to chemotherapy: report of five cases and review of the literature . Cancer . 1984; 53:1036-1041.Crossref 10. Newbill ET, Johns ME, Cantrell RW. Esthesioneuroblastoma: diagnosis and management . South Med J. 1985;78:275-282.Crossref 11. Kameya T, Shimosato Adachi I, Abe K, Ebihara S, Ono I. Neuroendocrine carcinoma of the paranasal sinuses: a morphological and endocrinologic study . Cancer . 1980;45:330-339.Crossref 12. Taxy JB, Bharani NK, Mills SE, Frierson HF Jr, Gould VE. The spectrum of olfactory neural tumors: a light-microscopic immunohistochemical and ultrastructural analysis . Am J Surg Pathol. 1986;10:687-695. 13. Silva EG, Butler JJ, Mackay B, Goepfert H. Neuroblastomas and neuroendocrine carcinomas of the nasal cavity: a proposed new classification . Cancer . 1982;50:2388-2405.Crossref 14. Foote RL, Morita A, Ebersold MJ, et al. Esthesioneuroblastoma: the role of adjuvant radiation therapy . Int J Radiat Oncol Biol Phys. 1993;27:835-842.Crossref 15. Dulguerov P, Calcaterra T. Esthesioneuroblastoma: the UCLA experience 1970-1990 . Laryngoscope . 1992;102:843-849.Crossref 16. Cantrell RW. Esthesioneuroblastoma . In: Sekhar LN, Janecka IP, eds. Surgery of Cranial Base Tumors . New York, NY: Raven Press; 1993:471-476. 17. Nakissa N, Rubin P, Strohl R, Keys H. Ocular and orbital complications following radiation therapy of paranasal sinus malignancies and review of the literature . Cancer . 1983;51:980-986.Crossref 18. Sisson G, Toriumi D, Atiyah RA. Paranasal sinus malignancy: a comprehensive update . Laryngoscope . 1989;99:143-150. 19. Zappia JJ, Carroll WR, Wolf GT, Thornton AF, Ho L, Krause CJ. Olfactory neuroblastoma: the results of modern treatment approaches at the University of Michigan . Head Neck . 1993;15:190-196.Crossref 20. Spaulding CA, Kranyak MS, Constable WC, Stewart FM. Esthesioneuroblastoma: a comparison of two treatment eras . Int J Radiat Oncol Biol Phys. 1988; 15:581-590.Crossref 21. Cheung NV, Heller G. Chemotherapy dose intensity correlates strongly with reponse, median survival and median progression-free survival in metastatic neuroblastoma . J Clin Oncol. 1991;9:1050-1058. 22. Polonowski JM, Brasnu D, Roux FX, Bassot V. Esthesioneuroblastoma: complete tumor response after induction chemotherapy . Ear Nose Throat J. 1990; 69:743-746. 23. Weiden PL, Yarington CT Jr, Richardson RG. Olfactory neuroblastoma: chemotherapy and radiotherapy for extensive disease . Arch Otolaryngol . 1984; 110:759-760.Crossref 24. O'Connor TA, McLean P, Juillard GJ, Parker RG. Olfactory neuroblastoma . Cancer . 1989;63:2426-2428.Crossref 25. Levine PA, Debo RF, Meredith SD, Jane JA, Constable WC, Cantrell RW. Craniofacial resection at the University of Virginia (1976-1992): survival analysis . Head Neck . 1994;16:574-577.Crossref 26. Richtsmeier WJ, Briggs RJ, Koch WM, et al. Complications and early outcome of anterior craniofacial resection . Arch Otolaryngol Head Neck Surg. 1992;118: 913-917.Crossref 27. Levine PA, Stewart FM, Cantrell RW, Constable WC. Esthesioneuroblastoma: long-term outcome and patterns of failure the—University of Virginia experience . Cancer . 1994;73:2556-2562.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Successful Treatment of Esthesioneuroblastoma and Neuroendocrine Carcinoma With Combined Chemotherapy and Proton Radiation: Results in 9 Cases

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1997.01900010038005
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Abstract

Abstract Objective: To study the efficacy of a newly designed treatment strategy for esthesioneuroblastoma and neuroendocrine carcinoma of the paranasal sinuses. Design and Setting: Nonrandomized prospective study of a case series in a tertiary referral center. Patients: Nine consecutive patients with newly diagnosed esthesioneuroblastoma or neuroendocrine carcinoma of the paranasal sinuses from June 1992 to October 1995 underwent this treatment protocol. Interventions: After histological diagnosis and detailed imaging, 2 cycles of cisplatin and etoposide chemotherapy were instituted. Chemotherapy responders were treated with combined photon and stereotaxic fractionated proton radiation therapy totaling approximately 68 Gy to the primary site, whereas poor responders were treated with surgical resection followed by postoperative radiation. In both cases, therapy was then concluded with 2 additional cycles of cisplatin and etoposide chemotherapy. Main Outcomes Measures: Response to therapy, survival, disease-free survival, and complications of therapy were examined. Results: Nine patients with a median Dulguerov T stage of T3 (range, T2 to T4) completed the treatment protocol, with mean follow-up after diagnosis of 20.5 months. Eight of 9 patients exhibited a dramatic response to therapy with remission of their tumor, and resection was not required. One patient failed to respond to induction chemotherapy and received surgical therapy to be followed by postoperative radiotherapy. There have been no recurrences (mean disease-free interval of 14.0 months). Complications were limited and generally transient. Conclusions: The use of combined cisplatin and etoposide chemotherapy with proton radiation has demonstrated initial success in treatment of these tumors. Dramatic response from chemotherapy is possible even in bulky or unresectable disease. This protocol has an acceptable complication rate and conveys less morbidity than craniofacial resection and conventional radiotherapy. Further follow-up will be required to determine the long-term success rate of this therapeutic protocol.Arch Otolaryngol Head Neck Surg. 1997;123:34-40 References 1. Morita A, Ebersold MJ, Olsen KD, Foote RL, Lewis JE, Quast LM. Esthesioneuroblastoma: prognosis and management . Neurosurgery . 1993;32:706-715.Crossref 2. Berger L, Luc R. L'esthesioneuroepitheliome olfactif . Bull Assoc Fr Etude Cancer . 1924;13:410-421. 3. Hyams VJ. Tumors of the upper respiratory tract and ear . In: Hyams VJ, Batsakis JG, Michaels L, eds. Atlas of Tumor Pathology . Washington, DC: Armed Forces Institute of Pathology; 1988:240-248. Second series, (pt 25) . 4. Kadish S, Goodman M, Wang CC. Olfactory neuroblastoma: a clinical analysis of 17 cases . Cancer . 1976;37:1571-1576.Crossref 5. Lund VJ, Milroy C. Olfactory neuroblastoma: clinical and pathological aspects . Rhinology . 1993;31:1-6. 6. Elkon D, Hightower SI, Lim ML, Cantrell RW, Constable WC. Esthesioneuroblastoma . Cancer . 1979;44:1087-1094.Crossref 7. Biller HF, Lawson W, Sachdev VP, Som P. Esthesioneuroblastoma: surgical treatment without radiation . Laryngoscope . 1990;100:1199-1201.Crossref 8. Levine PA, McClean WC, Cantrell RW. Esthesioneuroblastoma: the University of Virginia experience: 1960-1985 . Laryngoscope . 1986;96:742-746. 9. Wade PM Jr, Smith RE, Johns ME. Response of esthesioneuroblastoma to chemotherapy: report of five cases and review of the literature . Cancer . 1984; 53:1036-1041.Crossref 10. Newbill ET, Johns ME, Cantrell RW. Esthesioneuroblastoma: diagnosis and management . South Med J. 1985;78:275-282.Crossref 11. Kameya T, Shimosato Adachi I, Abe K, Ebihara S, Ono I. Neuroendocrine carcinoma of the paranasal sinuses: a morphological and endocrinologic study . Cancer . 1980;45:330-339.Crossref 12. Taxy JB, Bharani NK, Mills SE, Frierson HF Jr, Gould VE. The spectrum of olfactory neural tumors: a light-microscopic immunohistochemical and ultrastructural analysis . Am J Surg Pathol. 1986;10:687-695. 13. Silva EG, Butler JJ, Mackay B, Goepfert H. Neuroblastomas and neuroendocrine carcinomas of the nasal cavity: a proposed new classification . Cancer . 1982;50:2388-2405.Crossref 14. Foote RL, Morita A, Ebersold MJ, et al. Esthesioneuroblastoma: the role of adjuvant radiation therapy . Int J Radiat Oncol Biol Phys. 1993;27:835-842.Crossref 15. Dulguerov P, Calcaterra T. Esthesioneuroblastoma: the UCLA experience 1970-1990 . Laryngoscope . 1992;102:843-849.Crossref 16. Cantrell RW. Esthesioneuroblastoma . In: Sekhar LN, Janecka IP, eds. Surgery of Cranial Base Tumors . New York, NY: Raven Press; 1993:471-476. 17. Nakissa N, Rubin P, Strohl R, Keys H. Ocular and orbital complications following radiation therapy of paranasal sinus malignancies and review of the literature . Cancer . 1983;51:980-986.Crossref 18. Sisson G, Toriumi D, Atiyah RA. Paranasal sinus malignancy: a comprehensive update . Laryngoscope . 1989;99:143-150. 19. Zappia JJ, Carroll WR, Wolf GT, Thornton AF, Ho L, Krause CJ. Olfactory neuroblastoma: the results of modern treatment approaches at the University of Michigan . Head Neck . 1993;15:190-196.Crossref 20. Spaulding CA, Kranyak MS, Constable WC, Stewart FM. Esthesioneuroblastoma: a comparison of two treatment eras . Int J Radiat Oncol Biol Phys. 1988; 15:581-590.Crossref 21. Cheung NV, Heller G. Chemotherapy dose intensity correlates strongly with reponse, median survival and median progression-free survival in metastatic neuroblastoma . J Clin Oncol. 1991;9:1050-1058. 22. Polonowski JM, Brasnu D, Roux FX, Bassot V. Esthesioneuroblastoma: complete tumor response after induction chemotherapy . Ear Nose Throat J. 1990; 69:743-746. 23. Weiden PL, Yarington CT Jr, Richardson RG. Olfactory neuroblastoma: chemotherapy and radiotherapy for extensive disease . Arch Otolaryngol . 1984; 110:759-760.Crossref 24. O'Connor TA, McLean P, Juillard GJ, Parker RG. Olfactory neuroblastoma . Cancer . 1989;63:2426-2428.Crossref 25. Levine PA, Debo RF, Meredith SD, Jane JA, Constable WC, Cantrell RW. Craniofacial resection at the University of Virginia (1976-1992): survival analysis . Head Neck . 1994;16:574-577.Crossref 26. Richtsmeier WJ, Briggs RJ, Koch WM, et al. Complications and early outcome of anterior craniofacial resection . Arch Otolaryngol Head Neck Surg. 1992;118: 913-917.Crossref 27. Levine PA, Stewart FM, Cantrell RW, Constable WC. Esthesioneuroblastoma: long-term outcome and patterns of failure the—University of Virginia experience . Cancer . 1994;73:2556-2562.Crossref

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Jan 1, 1997

References