Stereotactic radiosurgery for distant brain metastases secondary to esthesioneuroblastoma: a single-institution series

Abstract

OBJECTIVE Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare, malignant tumor of neuroectodermal origin that arises from the olfactory neuroepithelium. In this study the authors present the first series in the literature on distant brain metastases (BMs) secondary to ENB that were treated with stereotactic radiosurgery (SRS), to evaluate the safety and effectiveness of SRS for this indication. METHODS A retrospective analysis of clinical and radiological outcomes of patients with ENB who underwent CyberKnife (CK) SRS at a single center was conducted. The clinical and radiological outcomes of patients, including progression-free survival, overall survival, and local tumor control (LTC) were reported. RESULTS Between 2003 and 2022, 32 distant BMs in 8 patients were treated with CK SRS at Stanford University. The median patient age at BM diagnosis was 62 years (range 47–75 years). Among 32 lesions, 2 (6%) had previously been treated with surgery, whereas for all other lesions (30 [94%]), CK SRS was used as their primary treatment modality. The median target volume was 1.5 cm3 (range 0.09–21.54 cm3). CK SRS was delivered by a median marginal dose of 23 Gy (range 15–30 Gy) and a median of 3 fractions (range 1–5 fractions) to a median isodose line of 77% (range 70%–88%). The median biologically effective dose was 48 Gy (range 21–99.9 Gy) and the median follow-up was 30 months (range 3–95 months). The LTC at 1-, 2-, and 3-year follow-up was 86%, 65%, and 50%, respectively. The median progression-free survival and overall survival were 29 months (range 11–79 months) and 51 months (range 15–79 months), respectively. None of the patients presented adverse radiation effects. CONCLUSIONS In the authors’ experience, SRS provided excellent LTC without any adverse radiation effects for BMs secondary to ENB.