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Stereotactic Radiosurgical Salvage Treatment for Locally Recurrent Esthesioneuroblastoma

Van Gompel, Jamie J. MD*; Carlson, Matthew L. MD; Pollock, Bruce E. MD*; Moore, Eric J. MD; Foote, Robert L. MD§; Link, Michael J. MD*,‡

doi: 10.1227/NEU.0b013e31827fcdc2
Research-Human-Clinical Studies

BACKGROUND: Esthesioneuroblastoma (ENB) is a rare malignant neuroendocrine tumor considered to be radiation sensitive. Local recurrence may be treated in a variety of ways, including stereotactic radiosurgery (SRS); however, little information on its effectiveness is available.

OBJECTIVE: To determine whether SRS is effective in providing local control for recurrent ENB.

METHODS: This was a retrospective single-institution experience including 109 patients with ENB treated at the Mayo Clinic (1962-2009). Sixty-three patients presented with Kadish stage C disease, and 21 patients developed local recurrence. Of these 21 patients, 7 patients underwent SRS at our institution and an additional patient underwent SRS after transnasal biopsy. Therefore, a total of 8 patients are reported.

RESULTS: The median age at time of local recurrence was 50 years. All patients had Kadish C disease at initial diagnosis. Six of 8 patients were found to have Hyams grade 3 disease; the remaining 2 patients had grade 2 disease. The median treatment volume was 8.4 cm3 (mean, 18.9 cm3; range, 1.4-76.3 cm3), and the median dose to the tumor margin was 15 Gy (mean, 14.4 ± 2.2 Gy; range, 10-18 Gy). Of the 16 treatments, 13 had adequate follow-up to assess treatment response, with 92% achieving local control over a median follow-up of 42 months from the time of SRS. Five lesions decreased in size, 7 lesions stabilized, and only 1 lesion had in-field progression. There were no documented complications secondary to SRS.

CONCLUSION: SRS appears to be a reasonable and safe option for treatment of intracranial recurrence of ENB.

ABBREVIATIONS: EBRT, external beam radiotherapy

ENB, esthesioneuroblastoma

SRS, stereotactic radiosurgery

Departments of *Neurosurgery

Otorhinolaryngology

§Radiation Oncology, Mayo Clinic, Rochester, Minnesota

Correspondence: Jamie J. Van Gompel, MD, Department of Neurosurgery, Mayo Clinic, 200 First St, SW, Rochester, MN 55905. E-mail: vangompel.jamie@mayo.edu

Reprint Requests: Michael J. Link MD, Department of Neurosurgery, Mayo Clinic, 200 First St, SW, Rochester, MN 55905. E-mail: link.michael@mayo.edu

Received July 15, 2012

Accepted November 07, 2012

Copyright © by the Congress of Neurological Surgeons