Sinonasal malignancies with neuroendocrine differentiation: Patterns of failure according to histologic phenotype

David I. Rosenthal, Jerry L. Barker, Adel K. El-Naggar, Bonnie S. Glisson, Merrill S. Kies, Eduardo M. Diaz, Gary L. Clayman, Franco DeMonte, Ugur Selek, William H. Morrison, K. Kian Ang, K. S.Clifford Chao, Adam S. Garden

Research output: Contribution to journalReview article

129 Citations (Scopus)

Abstract

BACKGROUND. Sinonasal neuroendocrine tumors are rare malignancies that are represented by a spectrum of histologies, including esthesioneuroblastoma (ENB), sinonasal undifferentiated carcinoma (SNUC), neuroendocrine carcinoma (NEC), and small cell carcinoma (SmCC). The authors reviewed their institutional experience to determine whether sinonasal neuroendocrine tumors of different histologies have distinct clinical characteristics that warrant individualized treatment approaches. METHODS. The authors treated 72 adults with pathologically proven, nonmetastatic, primary sinonasal neuroendocrine tumors from 1982 to 2002. There were 31 patients with ENB, 16 patients with SNUC, 18 patients with NEC, and 7 patients with SmCC. Patients with ENB usually were treated with local therapy alone (surgery and/or radiotherapy); only 3 of 31 patients (9.7%) received treatment (radiation) to regional lymphatics, and only 5 of 31 patients (16.1%) received chemotherapy. In contrast, patients with non-ENB histologies usually received chemotherapy (10 of 16 patients with SNUC, 12 of 18 patients with NEC, and 5 of 7 patients with SmCC), and nonsurgical locoregional therapy was used more frequently (6 of 16 patients with SNUC, 4 of 18 patients with NEC, and 5 of 7 patients with SmCC). RESULTS. The median follow-up for surviving patients was 81.5 months (range, 6-266 months). The Kaplan-Meier estimate of overall survival at 5 years was 93.1% for patients with ENB, 62.5% for patients with SNUC, 64.2% for patients with NEC, and 28.6% for patients with SmCC (P = 0.0029; log-rank test). The local control rate at 5 years also was superior for patients who had ENB (96.2%) compared with patients who had SNUC (78.6%), NEC (72.6%), or SmCC (66.7%) (P = 0.04). The regional failure (RF) rate at 5 years was 8.7% for patients with ENB, 15.6% for patients with SNUC, 12.9% for patients with NEC, and 44.4% for patients with SmCC. Additional late events increased the RF rate for patients with ENB to 31.9% at 10 years. The distant metastasis rate at 5 years was 0.0% for patients with ENB, 25.4% for patients with SNUC, 14.1% for patients with NEC, and 75.0% for patients with SmCC. CONCLUSIONS. This spectrum of malignancies with neuroendocrine features shares a common site of origin within the head and neck, but their natural histories appear to diverge into two main groups: ENB and non-ENB. Patients with ENB had excellent local and distant control rates with local therapy alone. Given the higher rates of systemic failure for patients with SNUC, NEC, and SmCC, the authors favor the use of combined-modality therapy for these patients.

Original languageEnglish (US)
Pages (from-to)2567-2573
Number of pages7
JournalCancer
Volume101
Issue number11
DOIs
StatePublished - Dec 1 2004

Fingerprint

Phenotype
Olfactory Esthesioneuroblastoma
Neoplasms
Neuroendocrine Carcinoma
Small Cell Carcinoma
Neuroendocrine Tumors
Histology
Therapeutics
Sinonasal undifferentiated carcinoma
Drug Therapy
Combined Modality Therapy

Keywords

  • Head and neck malignancies
  • Neuroendocrine carcinoma
  • Sinonasal carcinoma
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Sinonasal malignancies with neuroendocrine differentiation : Patterns of failure according to histologic phenotype. / Rosenthal, David I.; Barker, Jerry L.; El-Naggar, Adel K.; Glisson, Bonnie S.; Kies, Merrill S.; Diaz, Eduardo M.; Clayman, Gary L.; DeMonte, Franco; Selek, Ugur; Morrison, William H.; Ang, K. Kian; Chao, K. S.Clifford; Garden, Adam S.

In: Cancer, Vol. 101, No. 11, 01.12.2004, p. 2567-2573.

Research output: Contribution to journalReview article

@article{e0397274ea7f453fb5081f66160afef6,
title = "Sinonasal malignancies with neuroendocrine differentiation: Patterns of failure according to histologic phenotype",
abstract = "BACKGROUND. Sinonasal neuroendocrine tumors are rare malignancies that are represented by a spectrum of histologies, including esthesioneuroblastoma (ENB), sinonasal undifferentiated carcinoma (SNUC), neuroendocrine carcinoma (NEC), and small cell carcinoma (SmCC). The authors reviewed their institutional experience to determine whether sinonasal neuroendocrine tumors of different histologies have distinct clinical characteristics that warrant individualized treatment approaches. METHODS. The authors treated 72 adults with pathologically proven, nonmetastatic, primary sinonasal neuroendocrine tumors from 1982 to 2002. There were 31 patients with ENB, 16 patients with SNUC, 18 patients with NEC, and 7 patients with SmCC. Patients with ENB usually were treated with local therapy alone (surgery and/or radiotherapy); only 3 of 31 patients (9.7{\%}) received treatment (radiation) to regional lymphatics, and only 5 of 31 patients (16.1{\%}) received chemotherapy. In contrast, patients with non-ENB histologies usually received chemotherapy (10 of 16 patients with SNUC, 12 of 18 patients with NEC, and 5 of 7 patients with SmCC), and nonsurgical locoregional therapy was used more frequently (6 of 16 patients with SNUC, 4 of 18 patients with NEC, and 5 of 7 patients with SmCC). RESULTS. The median follow-up for surviving patients was 81.5 months (range, 6-266 months). The Kaplan-Meier estimate of overall survival at 5 years was 93.1{\%} for patients with ENB, 62.5{\%} for patients with SNUC, 64.2{\%} for patients with NEC, and 28.6{\%} for patients with SmCC (P = 0.0029; log-rank test). The local control rate at 5 years also was superior for patients who had ENB (96.2{\%}) compared with patients who had SNUC (78.6{\%}), NEC (72.6{\%}), or SmCC (66.7{\%}) (P = 0.04). The regional failure (RF) rate at 5 years was 8.7{\%} for patients with ENB, 15.6{\%} for patients with SNUC, 12.9{\%} for patients with NEC, and 44.4{\%} for patients with SmCC. Additional late events increased the RF rate for patients with ENB to 31.9{\%} at 10 years. The distant metastasis rate at 5 years was 0.0{\%} for patients with ENB, 25.4{\%} for patients with SNUC, 14.1{\%} for patients with NEC, and 75.0{\%} for patients with SmCC. CONCLUSIONS. This spectrum of malignancies with neuroendocrine features shares a common site of origin within the head and neck, but their natural histories appear to diverge into two main groups: ENB and non-ENB. Patients with ENB had excellent local and distant control rates with local therapy alone. Given the higher rates of systemic failure for patients with SNUC, NEC, and SmCC, the authors favor the use of combined-modality therapy for these patients.",
keywords = "Head and neck malignancies, Neuroendocrine carcinoma, Sinonasal carcinoma, Survival",
author = "Rosenthal, {David I.} and Barker, {Jerry L.} and El-Naggar, {Adel K.} and Glisson, {Bonnie S.} and Kies, {Merrill S.} and Diaz, {Eduardo M.} and Clayman, {Gary L.} and Franco DeMonte and Ugur Selek and Morrison, {William H.} and Ang, {K. Kian} and Chao, {K. S.Clifford} and Garden, {Adam S.}",
year = "2004",
month = "12",
day = "1",
doi = "10.1002/cncr.20693",
language = "English (US)",
volume = "101",
pages = "2567--2573",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "11",

}

TY - JOUR

T1 - Sinonasal malignancies with neuroendocrine differentiation

T2 - Patterns of failure according to histologic phenotype

AU - Rosenthal, David I.

AU - Barker, Jerry L.

AU - El-Naggar, Adel K.

AU - Glisson, Bonnie S.

AU - Kies, Merrill S.

AU - Diaz, Eduardo M.

AU - Clayman, Gary L.

AU - DeMonte, Franco

AU - Selek, Ugur

AU - Morrison, William H.

AU - Ang, K. Kian

AU - Chao, K. S.Clifford

AU - Garden, Adam S.

PY - 2004/12/1

Y1 - 2004/12/1

N2 - BACKGROUND. Sinonasal neuroendocrine tumors are rare malignancies that are represented by a spectrum of histologies, including esthesioneuroblastoma (ENB), sinonasal undifferentiated carcinoma (SNUC), neuroendocrine carcinoma (NEC), and small cell carcinoma (SmCC). The authors reviewed their institutional experience to determine whether sinonasal neuroendocrine tumors of different histologies have distinct clinical characteristics that warrant individualized treatment approaches. METHODS. The authors treated 72 adults with pathologically proven, nonmetastatic, primary sinonasal neuroendocrine tumors from 1982 to 2002. There were 31 patients with ENB, 16 patients with SNUC, 18 patients with NEC, and 7 patients with SmCC. Patients with ENB usually were treated with local therapy alone (surgery and/or radiotherapy); only 3 of 31 patients (9.7%) received treatment (radiation) to regional lymphatics, and only 5 of 31 patients (16.1%) received chemotherapy. In contrast, patients with non-ENB histologies usually received chemotherapy (10 of 16 patients with SNUC, 12 of 18 patients with NEC, and 5 of 7 patients with SmCC), and nonsurgical locoregional therapy was used more frequently (6 of 16 patients with SNUC, 4 of 18 patients with NEC, and 5 of 7 patients with SmCC). RESULTS. The median follow-up for surviving patients was 81.5 months (range, 6-266 months). The Kaplan-Meier estimate of overall survival at 5 years was 93.1% for patients with ENB, 62.5% for patients with SNUC, 64.2% for patients with NEC, and 28.6% for patients with SmCC (P = 0.0029; log-rank test). The local control rate at 5 years also was superior for patients who had ENB (96.2%) compared with patients who had SNUC (78.6%), NEC (72.6%), or SmCC (66.7%) (P = 0.04). The regional failure (RF) rate at 5 years was 8.7% for patients with ENB, 15.6% for patients with SNUC, 12.9% for patients with NEC, and 44.4% for patients with SmCC. Additional late events increased the RF rate for patients with ENB to 31.9% at 10 years. The distant metastasis rate at 5 years was 0.0% for patients with ENB, 25.4% for patients with SNUC, 14.1% for patients with NEC, and 75.0% for patients with SmCC. CONCLUSIONS. This spectrum of malignancies with neuroendocrine features shares a common site of origin within the head and neck, but their natural histories appear to diverge into two main groups: ENB and non-ENB. Patients with ENB had excellent local and distant control rates with local therapy alone. Given the higher rates of systemic failure for patients with SNUC, NEC, and SmCC, the authors favor the use of combined-modality therapy for these patients.

AB - BACKGROUND. Sinonasal neuroendocrine tumors are rare malignancies that are represented by a spectrum of histologies, including esthesioneuroblastoma (ENB), sinonasal undifferentiated carcinoma (SNUC), neuroendocrine carcinoma (NEC), and small cell carcinoma (SmCC). The authors reviewed their institutional experience to determine whether sinonasal neuroendocrine tumors of different histologies have distinct clinical characteristics that warrant individualized treatment approaches. METHODS. The authors treated 72 adults with pathologically proven, nonmetastatic, primary sinonasal neuroendocrine tumors from 1982 to 2002. There were 31 patients with ENB, 16 patients with SNUC, 18 patients with NEC, and 7 patients with SmCC. Patients with ENB usually were treated with local therapy alone (surgery and/or radiotherapy); only 3 of 31 patients (9.7%) received treatment (radiation) to regional lymphatics, and only 5 of 31 patients (16.1%) received chemotherapy. In contrast, patients with non-ENB histologies usually received chemotherapy (10 of 16 patients with SNUC, 12 of 18 patients with NEC, and 5 of 7 patients with SmCC), and nonsurgical locoregional therapy was used more frequently (6 of 16 patients with SNUC, 4 of 18 patients with NEC, and 5 of 7 patients with SmCC). RESULTS. The median follow-up for surviving patients was 81.5 months (range, 6-266 months). The Kaplan-Meier estimate of overall survival at 5 years was 93.1% for patients with ENB, 62.5% for patients with SNUC, 64.2% for patients with NEC, and 28.6% for patients with SmCC (P = 0.0029; log-rank test). The local control rate at 5 years also was superior for patients who had ENB (96.2%) compared with patients who had SNUC (78.6%), NEC (72.6%), or SmCC (66.7%) (P = 0.04). The regional failure (RF) rate at 5 years was 8.7% for patients with ENB, 15.6% for patients with SNUC, 12.9% for patients with NEC, and 44.4% for patients with SmCC. Additional late events increased the RF rate for patients with ENB to 31.9% at 10 years. The distant metastasis rate at 5 years was 0.0% for patients with ENB, 25.4% for patients with SNUC, 14.1% for patients with NEC, and 75.0% for patients with SmCC. CONCLUSIONS. This spectrum of malignancies with neuroendocrine features shares a common site of origin within the head and neck, but their natural histories appear to diverge into two main groups: ENB and non-ENB. Patients with ENB had excellent local and distant control rates with local therapy alone. Given the higher rates of systemic failure for patients with SNUC, NEC, and SmCC, the authors favor the use of combined-modality therapy for these patients.

KW - Head and neck malignancies

KW - Neuroendocrine carcinoma

KW - Sinonasal carcinoma

KW - Survival

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U2 - 10.1002/cncr.20693

DO - 10.1002/cncr.20693

M3 - Review article

C2 - 15517582

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JO - Cancer

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SN - 0008-543X

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