Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb;71(2):e30793.
doi: 10.1002/pbc.30793. Epub 2023 Nov 29.

Outcomes following proton therapy for pediatric esthesioneuroblastoma

Nicolette R Drescher  1 , Daniel J Indelicato  1 , Roi Dagan  1 , Julie A Bradley  1 , Adam L Holtzman  2 , Raymond B Mailhot Vega  1 , Philipp R Aldana  3 , Eric S Sandler  4 , Christopher G Morris  1 , William M Mendenhall  1
Affiliations

Outcomes following proton therapy for pediatric esthesioneuroblastoma

Nicolette R Drescher et al. Pediatr Blood Cancer. 2024 Feb.

Abstract

Background: Pediatric esthesioneuroblastoma (EN) can infiltrate skull base anatomy, presenting challenges due to high radiation doses and pediatric tissue sensitivity. This study reports outcomes of pediatric EN treated with proton radiotherapy (PT).

Procedure: Using an IRB-approved prospective outcomes registry, we evaluated patient, tumor, and treatment-related variables impacting disease control and toxicity in pediatric nonmetastatic EN treated with modern multimodality therapy, including PT.

Results: Fifteen consecutive patients (median age 16) comprising Kadish stage B (n = 2), C (n = 9), and D (n = 4) tumors were assessed, including six with intracranial involvement, four with cranial nerve deficits, and four with cervical lymphadenopathy. Before radiation, two had subtotal and 13 had gross total resections (endoscopic or craniofacial). Two underwent neck dissection. Eleven received chemotherapy before radiation (n = 5), concurrent with radiation (n = 4), or both (n = 2). Median total radiation dose (primary site) was 66 Gy/CGE for gross disease and 54 Gy/CGE (cobalt Gray equivalent) for microscopic disease. Median follow-up was 4.8 years. No patients were lost to follow-up. Five-year disease-free and overall survival rates were 86% (no local or regional recurrences). Two patients developed vertebral metastases and died. Two required a temporary feeding tube for oral mucositis/dysphagia. Late toxicities included symptomatic retinopathy, major reconstructive surgery, cataracts, chronic otitis media, chronic keratoconjunctivitis, hypothyroidism, and in-field basal cell skin cancer.

Conclusions: A multimodality approach for pediatric EN results in excellent local control. Despite the moderate-dose PT, serious radiation toxicity was observed; further dose and target volume reductions may benefit select patients. Longer follow-up and comparative data from modern photon series are necessary to fully characterize any relative PT advantage.

Keywords: esthesioneuroblastoma; overall survival; pediatric; peds EN; proton.

PubMed Disclaimer

References

REFERENCES

    1. Dulguerov P, Allal AS, Calcaterra TC. Esthesioneuroblastoma: a meta-analysis and review. Lancet Oncol. 2001;2(11):683-690. doi:10.1016/S1470-2045(01)00558-7
    1. Monroe AT, Hinerman RW, Amdur RJ, Morris CG, Mendenhall WM. Radiation therapy for esthesioneuroblastoma: rationale for elective neck irradiation. Head Neck. 2003;25(7):529-534. doi:10.1002/hed.10247
    1. Benoit MM, Bhattacharyya N, Faquin W, Cunningham M. Cancer of the nasal cavity in the pediatric population. Pediatrics. 2008;121(1):e141-e145. doi:10.1542/peds.2007-1319
    1. Hollen TR, Morris CG, Kirwan JM, et al. Esthesioneuroblastoma of the nasal cavity. Am J Clin Oncol. 2015;38(3):311-314. doi:10.1097/COC.0b013e31829b5631
    1. Kumar R. Esthesioneuroblastoma multimodal management and review of literature. World J Clin Cases. 2015;3(9):774-778. doi:10.12998/wjcc.v3.i9.774