ESTHESIONEUROBLASTOMA - THE ROLE OF ADJUVANT RADIATION-THERAPY

Purpose: We describe our experience with adjuvant radiation therapy in patients who underwent operation for esthesioneuroblastoma. Methods a nd Materials: Between January 1951 and December 1990, 49 patients with esthesioneuroblastoma received their initial treatment at the Mayo Cl inic. There were 27 male and 22 female patients; their ages ranged fro m 3 to 79 years (median, 54 years). The tumors were Kadish Stage A in 4 patients, Stage B in 13, Stage C in 29, and modified Kadish Stage D in three (cervical nodal or distant metastasis). The tumors were grade d according to Hyams' classification. Treatment included gross total r esection alone in 22 patients and gross total resection and postoperat ive adjuvant radiation therapy in 16. The patients treated with adjuva nt radiation had a greater proportion of advanced-stage and high-grade tumors. Results: The 5-year actuarial overall survival, disease-free survival, and local control rates were 69.1% + 7.0%, 54.8% + 7.6%, and 65.3% + 7.4%, respectively. The only significant predictor for overal l survival, disease-free survival, and local control was Hyams' grade. Local control was improved in patients who received postoperative adj uvant radiation even though this group of patients had more advanced a nd higher-grade tumors (5-year rate of local control was 85.9% + 9.3%, compared with 72.7% + 9.5% for those who had operation alone, p = 0.2 6). Conclusion: Adjuvant radiation therapy for esthesioneuroblastoma i mproves local tumor control, particularly for high-grade and high-stag e tumors. We recommend additional treatment with radiation (55.5 Gy) a fter complete resection of esthesioneuroblastoma.