THE ROLE OF PREOPERATIVE ADJUVANT TREATMENT IN THE MANAGEMENT OF ESTHESIONEUROBLASTOMA - THE UNIVERSITY-OF-VIRGINIA EXPERIENCE

OBJECTIVE: Multidisciplinary management of esthesioneuroblastoma has e ffected markedly increased survival during the past 20 years. The pote ntial for radical craniofacial surgery for complete en bloc resection, the availability of advanced neuroimaging modalities, and the incorpo ration of neoadjuvant therapy into treatment strategies for tumor remi ssion have all contributed to this accomplishment. However, a standard protocol for the management of these lesions has not been accepted; p reoperative radiation and chemotherapy have been advocated, but neithe r radiographic nor clinical response has been quantified. METHODS: Thi rty-four consecutive patients with biopsy-proven esthesioneuroblastoma treated at one institution from 1976 to 1994 were reviewed to determi ne the effects of preoperative radiation therapy, with or without chem otherapy, on tumor size and long-term survival. RESULTS: In a multivar iate regression analysis, advanced age was predictive of decreased dis ease-free survival (P = 0.008), whereas advanced Kadish stage was asso ciated with a borderline higher rate of disease-related mortality (P = 0.056). Two-thirds of the patients showed a significant reduction in tumor burden with adjuvant therapy. Patients with response to neoadjuv ant therapy demonstrated a significantly lower rate of disease-related mortality (P = 0.030). In this series, the overall 5- and 10-year sur vival rates were 81.0 and 54.5%, respectively. CONCLUSION: Preoperativ e neoadjuvant therapy provides a valuable complement to radical cranio facial resection, leading to reduction in tumor burden. Patients exper iencing reduction in tumor Volume by neoadjuvant therapy demonstrate a n improved prognosis.