AHNS Journal Club – July 2020

Volume 32 – July, 2020

The AHNS Journal Club reviews the leading head and neck cancer-related journals, sharing with AHNS members some of the most relevant and important manuscripts, and providing summaries and critiques of the work.

The Journal Club for the July issue: AHNS Skull Base Surgery Edition

This Issue of the AHNS Journal Club has been compiled and reviewed by members of the

AHNS Skull Base Surgery Section (Ivan El-Sayed, Chair; Ian Witterick, Co-Chair)

 Meghan Turner
Marilene Wang
Shirley Su
Harishanker Jeyarajan

Dear Colleagues,

The AHNS Skull Base Surgery Section is very pleased to present its first AHNS Journal Club Issue.  Our ultimate goal for the Skull Base Surgery Section issues will be to provide insight into contemporary management of skull base tumors through themed issues.  This particular issue will address controversies in the recently published literature on nodal metastases in olfactory neuroblastoma (ONB) by reviewing the recently published literature.

Traditionally, elective treatment of cervical nodal metastases for head and neck primaries is advocated when the risk of occult metastases reaches > 20%.  However, sinonasal malignancy (as a group) has been shown to have a lower incidence of cervical metastases on presentation making elective treatment of the neck in sinonasal malignancy controversial and somewhat rare. With respect to ONB, the incidence of nodal metastases at the time of diagnosis (modified Kadish stage D) is low, approximately 8%.^1,2  In spite of this rare incidence at diagnosis, up to 20.2% of patients with ONB will develop nodal disease within 5 years of diagnosis.³

Single institution studies have tried to identify risk factors for nodal recurrence (positive margins, modified Kadish C Staging, Hyam’s grade, the presence of dural invasion) and identify patients who might benefit from elective treatment of the neck.^4-6  This has led to more recent studies examining elective treatment of high-risk nodal basins including retropharyngeal, level IB and level II lymph nodes.⁷  Elective neck irradiation provides 100% locoregional control in small, single-institution series, but was associated with worse overall survival in patients over 50.  Salvage treatment of the delayed nodal recurrence has 5-year LRC rates of 30-80% and is highest when both surgery and radiation are used.^3,6  It remains unclear whether or not elective treatment of the neck reduces distant metastasis or has meaningful impact on survival as metastases are largely found in the brain, leptomeningeal spine, or the spinal skeleton.^6,7

In this issue, we present recent evidence regarding nodal metastases in ONB.  It is suggested you read them in the order presented.  We believe this evidence may impact future trends in the treatment of ENB and hope you enjoy this issue.  Comments are welcome and can be sent to meghan.turner@hsc.wvu.edu.

Sincerely,

Meghan T. Turner, MD
Assistant Professor of Head and Neck Surgery
West Virginia University Health Sciences Center

Marilene Wang, MD
Professor of Head and Neck Surgery
Ronald Reagan UCLA Medical Center

Harishanker Jeyarajan, MD
Assistant Professor of Head and Neck Surgery
University of Alabama Birmingham School of Medicine

Shirley Y. Su, MBBS
Associate Professor of Head and Neck Surgery
Associate Professor of Neurosurgery
The University of Texas M.D. Anderson Cancer Center

1. Kuan EC, Nasser HB, Carey RMet al. A Population-Based Analysis of Nodal Metastases in Esthesioneuroblastomas of the Sinonasal Tract. Laryngoscope 2019; 129:1025-1029.
2. Konuthula N, Iloreta AM, Miles Bet al. Prognostic significance of Kadish staging in esthesioneuroblastoma: An analysis of the National Cancer Database. Head Neck 2017; 39:1962-1968.
3. Gore MR, Zanation AM. Salvage treatment of late neck metastasis in esthesioneuroblastoma: a meta-analysis. Arch Otolaryngol Head Neck Surg 2009; 135:1030-1034.
4. Marinelli JP, Janus JR, Van Gompel JJet al. Dural Invasion Predicts the Laterality and Development of Neck Metastases in Esthesioneuroblastoma. J Neurol Surg B Skull Base 2018; 79:495-500.
5. Nalavenkata SB, Sacks R, Adappa NDet al. Olfactory Neuroblastoma: Fate of the Neck–A Long-term Multicenter Retrospective Study. Otolaryngol Head Neck Surg 2016; 154:383-389.
6. Banuchi VE, Dooley L, Lee NYet al. Patterns of regional and distant metastasis in esthesioneuroblastoma. Laryngoscope 2016; 126:1556-1561.
7. Jiang W, Mohamed ASR, Fuller CDet al. The role of elective nodal irradiation for esthesioneuroblastoma patients with clinically negative neck. Pract Radiat Oncol 2016; 6:241-247.

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