More Experience Needed for Endoscopic Resection of Esthesioneuroblastoma

It is extremely important, in analyzing the remaining studies, to remember that the mean time for recurrence of five years, accepted for most other cancers, is not valid in head and neck cancer. Hence the survival data for 10, 15, and 20 years are important to evaluate treatment efficacy, he said.

We have consistently shared the survival results of our esthesioneuroblastoma group, he said. Recognizing that this was an orphan illness, we knew it would take time and need a concerted data collection effort to assure that our results had significance. It has also been accepted that only follow-up for greater than six years with a substantial cohort size had to be seriously considered as valid evaluated treatment option for this tumor.

Dr. Levine noted that in 2006, the disease-free survival for complete management of 50 consecutive patients was 86.5% at five years. More importantly, we had an 82.6% disease-free survival at 15 years, he said.

In his featured lecture, he provided updated information on 60 patients-treated since 1976-with a 20-year overall disease-free survival of 81.2%. The figures represent only patients for whom the facility has provided complete therapy. It does not include patients who were provided salvage therapy after initial treatment elsewhere.

Dr. Levine cited other major series of esthesioneuroblastoma patients by Lund (2003) noting a five-year disease free survival of 77% and a 10-year survival of 53%; by Broich (1997), who published outcomes of 945 patients treated over a period of more than 70 years and had a five-year survival with radiation and surgery of 72.5%; and by Dulguerov (2001), who performed a meta-analysis of 390 patients between 1990 and 2000 of ethesioneuroblastoma patients in 26 studies and found a five-year disease-free survival of 45%, but when radiation and surgery were combined, there was a 65% survival.

Is Endoscopy the Way to Go?

Given the advances in endoscopic surgery and intraroperative imaging, it is not difficult to understand the tendency to expand the approach with an endoscopic treatment of benign sinonasal disease to that of neoplasm, Dr. Levine said.

He cited a number of series of endoscopic procedures, but the numbers were small (10 to 20 patients), and the follow-up time was relatively short (less than 5 years), which reflects the fact that the procedure has only recently been attempted.

Age and experience may breed some risk aversion, but I hope I am not falling into the trap of slavishly following a conservative approach, he said. As the old conservative has reportedly been quoted: ‘I have seen a lot of progress in my time, and I’ve been against it all.’