Esthesioneuroblastoma: The University of Iowa experience 1978-1998

Objective: Esthesioneuroblastoma is rare and the best treatment has yet to be defined. The purpose of this study is to analyze the natural history, tr eatment, and patterns of failure of esthesioneuroblastoma treated at one in stitution. Methods: Between 1978 and 1998, 13 patients with esthesioneurobl astoma were identified using the University of Iowa Tumor Registry. All pat ients were staged according to Kadish criteria. Mean follow-up was 6.3 year s. Six patients had 5 or more years of follow-up and four had follow-up exc eeding 9.5 years. One patient was lost to follow-up at 36 months. Results: No patients had Kadish stage A disease, five were stage B, and eight stage C, Overall actuarial 5- and 10-year survival rate was 61% and 24%, respecti vely. Disease-free survival rate at 5 and 10 years was 56% and 42%, respect ively. Seven patients have died, three of intercurrent disease and three of disease progression, one with an unknown disease status. Six patients rema in alive, three without evidence of disease and three have experienced a lo cal or regional recurrence. Five patients who were initially controlled dev eloped recurrence, three local only, one locoregional, and one regional and distant. Median time to failure was 96 months. All patients with follow-up exceeding 12 years have experienced either a local or regional recurrence. Survival after salvage therapy in these patients ranged from 3 to 12 years . Conclusion: Esthesioneuroblastoma has a long natural history characterize d by frequent local or regional recurrence after conventional treatment. Su ccessful retreatment can lead to prolonged survival.