Open AccessInduction Therapy Prior to Surgical Resection for Patients Presenting with Locally Advanced Esthesioneuroblastoma
Author(s) -
Kevin Miller,
John P. Marinelli,
Jeffrey R. Janus,
Ashish V. Chintakuntlawar,
Robert L. Foote,
Michael J. Link,
Garret Choby,
Jamie J. Van Gompel
Publication year - 2020
Publication title -
journal of neurological surgery. part b, skull base
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.488
H-Index - 42
eISSN - 2193-6331
pISSN - 2193-634X
DOI - 10.1055/s-0039-3402026
Subject(s) - esthesioneuroblastoma , medicine , surgery , induction chemotherapy , malignancy , radiation therapy , resection margin , chemotherapy , frozen section procedure , surgical margin , resection
Esthesioneuroblastoma (ENB) is a rare olfactory malignancy that can present with locally advanced disease. At our institution, patients with ENB in whom the treating surgeon believes that a margin-negative resection is initially not achievable are selected to undergo induction with chemotherapy with or without radiotherapy prior to surgery. In a retrospective review of 61 patient records, we identified six patients (10%) treated with this approach. Five of six patients (83%) went on to definitive surgery. Prior to surgery, three of five patients (60%) had a partial response after induction therapy, whereas two of five (40%) had stable disease. Microscopically margin-negative resection was achieved in four of five (80%) of the patients who went on to surgery, while one patient had negative margins on frozen section but microscopically positive margins on permanent section. Three of five patients (60%) recurred after surgery; two of these patients died with recurrent/metastatic ENB. In summary, induction therapy may facilitate margin-negative resection in locally advanced ENB. Given the apparent sensitivity of ENB to chemotherapy and radiotherapy, future prospective studies should investigate the optimal multidisciplinary approach to improve long-term survival in this rare disease.