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ICAR SINONASAL TUMORS

TABLE XIII.5 Evidence surrounding neck management in N0 olfactory neuroblastoma.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Peacock et al. 429

1. Radiotherapy significantly reduces local recurrence 2. Treatment of the N0 neck is not recommended and can be observed for clinical evidence of cervical disease 1. No difference in OS and DFS with or without ENI 2. ENI resulted in improved regional control 3. Rescue treatment of neck is effective 1. N + at presentation was an independent prognostic factor for a poor OS 2. No difference in OS and PFS with or without ENI 3. ENI reduced the regional failure significantly 4. No difference in DMFS with or without ENI 5. Rescue treatment of neck is effective 1. No difference in OS and DFS with or without ENI 2. ENI reduced the regional failure significantly 3. No difference in DMFS with or without ENI

1. RFS 2. Cervical LN RFS 3. DMRFS 4. ARFS 5. OS

2017 3

Retrospective cohort

52 ONB treated with either SART or SA

without elective neck dissection

Jiang et al. 455

2015 3

Retrospective cohort

71 ONB modified Kadish A/B/C ENI + ( n = 22) versus ENI– ( n = 49)

1. OS 2. PFS 3. LRC 4. DM

Songet al. 457

1. OS 2. PFS 3. RFS 4. DMFS 5. Incidence

2020 4

Retrospective case series

217 ONB treated with combination of RT,

chemotherapy and/or surgical resection

and location of lymph node metastasis

Yinet al. 456

2015 4

Retrospective case series

80 ONB modified KadishB/C ENI + ( n = 50) versus ENI– ( n = 30)

OS DFS RRFS DMFS

Abbreviations: ARFS, any recurrence-free survival; DMRFS, distant metastasis recurrence-free survival; ENI, elective neck irradiation; ENI + , receiving elective neck irradiation; ENI–, not receiving elective neck irradiation; LN, lymph node; LNM, late neck metastases; ND, neck dissection; OS, overall survival; PFS, progression-free survival; RFS, recurrence-free survival; RRFS, regional recurrence free; SA, surgery alone; SART, surgery and adjuvant radiotherapy.

Two histological subtypes that have treatment outcomes compared, though not within the same cohorts, between primary and salvage therapy are maxillary sinus SCC and ONB. Homma et al. reported a 5-year OS of 67.6% in 54 patients primarily treated with RADPLAT for maxillary SCC. 454 Similar survival rates have also been seen for recur rent maxillary SCC initially treated with RADPLAT, with a study reporting a 5-year OS of 68% for salvage surgery for these tumors. 434 However, survival outcomes were lower in a study by Ono et al. who observed a 2-year OS of 45.8% of patients undergoing salvage surgery and 11.1% for patients treated only with chemotherapy or palliation. 433 The management of the N0 neck in patients with ONB has also been well studied. Interestingly, although there is significant evidence showing that elective neck irradiation (ENI) decreases the rate of late neck metastasis, three stud ies have failed to show that this translates into improved OS (Table XIII.5). 455–457 Whether forgoing ENI in ONB patients and only treating recurrent neck disease when it

occurs is something that warrants further study. This is supported by the series from Peacock et al. that included 58 ONB patients with a mean follow-up of 13.8 years. 429 They showed a 4-year regional RFS of 70% after neck salvage surgery with or without RT and concluded that, although delayed cervical lymph node metastasis is common, it is generally indolent and can be managed effectively with salvage treatment in most patients. Aggregate grade of evidence : C (Level 3: two studies; Level 4: two studies) Recurrent SNM disease creates various treatment chal lenges with limited research available and thus eligible patients should be assessed systematically by a multi disciplinary team with experience in surgical salvage, reirradiation, chemotherapy, systemic therapies, and pal liative care. Where possible, treatment should be based on prognostic indicators as well as the morbidity associ ated with the different treatment modalities. SNM presents a significant rate of failure after initial successful treat-