2025 Poster Presentations
P020: ENDOSCOPIC ENDONASAL APPROACH IN ESTHESIONEUROBLASTOMA: EFFICACY, PROGNOSIS, AND RECURRENCE RATES
Rodrigo Cavalcante, MD, PhD; Luiz Netto, MD; Jairo Junior, MD; HC-UFG
Introduction: Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is an uncommon and aggressive tumor originating in the olfactory neuroepithelium. Given its rarity and variability in clinical presentation, treatment outcomes can be unpredictable. This study aims to present a series of cases of esthesioneuroblastoma treated via the endoscopic endonasal transsphenoidal transcribiform approach, evaluate the clinical outcomes, identify potential prognostic factors, and assess the impact of adjuvant treatment modalities on overall survival.
Methods: We conducted a case series study at a reference oncology hospital, focusing on patients operated on by the same surgeon. Ten cases were reviewed, documenting patient sex, age, tumor grading (Hyams and modified Kadish stages), radiation therapy (RT) specifics, surgical interventions, presence of previous surgeries, additional clinical findings, and patient outcomes post-treatment. The significance of prognostic factors was determined using Cox proportional hazards regression models. A p-value of <0.05 was considered statistically significant. All analyses were performed by R Software, version 4.2 (The R Foundation, USA).
Results: Standard treatment typically involves surgical resection followed by radiotherapy, using the endoscopic endonasal approach (EEA) due to its minimally invasive nature. Our case series included ten patients aged 38 to 70, with a mean age of 52.2 years. Six patients (60%) were male, and four (40%) were female. Among the patients, eight were classified with seven (70%) classified as Kadish C, one (10%) as Kadish D, and two B (20%). Hyams grades ranged from 1 to 4. One patient (10%) was classified as Hyams grade 1, five (50%) as grades 2, two (20%) as grade 3, and two (20%) as grade 4. All patients underwent surgery, and eight (80%) received radiotherapy. Four patients (40%) received adjuvant chemotherapy based on individual assessments. Additionally, six patients (60%) had undergone prior transcranial surgery. Long-term follow-up is crucial due to the potential for tumor recurrence. Patients with high-grade Hyams (Grade 3 or 4) had a lower overall survival compared to patients with low-grade Hyams (Grade 1 or 2), regardless of adjuvant therapies such as radiotherapy and chemotherapy. The 5-year overall survival for patients with low-grade Hyams was 50%, whereas no patients with high grade Kadish tumors (C or D), they also showed greater aggressiveness and lower survival, with a 5-year overall survival of 30%, compared to 50% for patients with low-grade tumors (A or B).
Conclusion: This study highlights the effectiveness of a multimodal treatment strategy for ENB, particularly for advanced-stage and high-grade tumors. The EEA is increasingly recognized for improving patient outcomes, especially in lower-stage tumors. Long-term monitoring is critical for detecting and managing late recurrences. Further research with larger cohorts is necessary to establish standardized treatment protocols and improve prognostic predictions. Patients with more aggressive tumors, according to both Hyams and Kadish classifications, had worse overall survival, regardless of adjuvant therapies, especially chemotherapy, which was used for more aggressive tumors.