Treatment of Esthesioneuroblastoma

Esthesioneuroblastoma, or olfactory neuroblastoma, is a rare form of cancer that starts in the upper part of the nasal cavity. Effective treatment usually requires a combination of approaches, including surgery, radiation therapy, and sometimes chemotherapy.

Each treatment plan is uniquely tailored to fit the needs of the patient, based on the tumor’s stage, grade, and location. This article provides an outline on the standard treatments for esthesioneuroblastoma, hoping to help patients and caregivers feel more informed and prepared for what to expect on this journey.

Following diagnosis, surgery is often the first step in treating esthesioneuroblastoma, with a goal of removing as much of the tumor as possible.

• Endoscopic Surgery: For smaller tumors, minimally invasive endoscopic surgery is preferred. This method allows surgeons to remove the tumor through the nostrils, minimizing recovery time and reducing scarring.

• Open Craniofacial Resection: For larger or more invasive tumors, a more extensive surgical approach may be necessary. This procedure involves making incisions near the nose and skull to access and remove the tumor. Although more invasive, it can potentially reduce the risk of recurrence.
• Importance of Complete Resection: Complete surgical removal is critical for lowering the risk of the tumor regrowing. However, because these tumors grow close to sensitive structures, surgery carries some risks, such as potential impacts on vision or smell.

Radiation therapy is commonly recommended after surgery to target any remaining cancer cells and help prevent recurrence. For patients who cannot undergo surgery, it can also be used as the main form of treatment.

• External Beam Radiation: High-energy beams are directed at the tumor to kill cancer cells. This method can be targeted to minimize damage to surrounding healthy tissues.

• Proton Therapy: This is a more advanced form of radiation that delivers radiation directly to the tumor with less risk to adjacent tissues. This makes it particularly useful when the tumor is near critical areas like the brain.

Chemotherapy uses drugs to stop the growth of cancer cells. While not typically the first treatment choice, it may be used alongside other treatments in certain situations.

• When Chemotherapy is Used: Chemotherapy may be recommended if the tumor has spread, if there is a high risk of recurrence, or when surgery cannot completely remove the tumor. Sometimes, it’s used with radiation to improve treatment effectiveness.
• Types of Drugs: Common chemotherapy drugs for esthesioneuroblastoma include cisplatin and etoposide, which are usually given in cycles to allow the body time to recover between treatments.

For patients with recurrent or resistant esthesioneuroblastoma, clinical trials may offer access to new and experimental treatments. More information regarding clinical trials can be found here.

Targeted therapies focus on specific molecules that cancer cells need to grow. This precision can reduce side effects and improve outcomes, and ongoing research is exploring how these treatments can be used effectively for esthesioneuroblastoma.

Supportive care is an essential component of treatment, helping patients manage side effects and maintain their quality of life.

• Symptom Management: Side effects from treatment, such as nausea, fatigue, and pain, can often be managed with medication, dietary changes, or physical therapy.
• Rehabilitation: Post-treatment rehabilitation may be necessary to help patients regain lost motor or sensory functions, especially if surgery affects nearby structures. Physical and occupational therapy can aid in recovery.
• Emotional Support: A cancer diagnosis and treatment can be emotionally challenging. Access to counseling and support groups can provide emotional and mental support, helping patients and caregivers navigate the complexities of their journey.

The risk of recurrence is a major concern with esthesioneuroblastoma. Regular follow-up appointments are crucial for monitoring any signs of the tumor returning.

Follow-up care usually includes periodic imaging and physical exams. Early detection of recurrence allows for more immediate intervention, which can significantly improve outcomes.

The prognosis for esthesioneuroblastoma depends on factors like tumor stage, grade, and location, as well as the extent of surgical removal. Lower-grade tumors typically have a more favorable prognosis, and early diagnosis is key to successful treatment.

Treating esthesioneuroblastoma involves a combination of surgery, radiation, and sometimes chemotherapy. Each patient's treatment plan is personalized to ensure the best possible outcome, focusing on complete tumor removal while managing side effects and maintaining quality of life.

With advances in treatment techniques and ongoing research, there is hope for improved outcomes and a brighter future for those affected by this rare cancer.

• Surgery is the primary treatment for esthesioneuroblastoma, with the goal of complete tumor removal to minimize recurrence risk.
• Radiation therapy is often used after surgery to target residual cancer cells, with advanced options like proton therapy offering precise targeting.
• Chemotherapy may be considered when surgery and radiation alone are insufficient, particularly in cases of spread or high-risk tumors.
• Supportive care is vital in helping patients manage side effects and maintain their quality of life during and after treatment.
• Clinical trials and targeted therapies are emerging as new options, especially for cases where conventional treatments are less effective.

• National Cancer Institute - Olfactory Neuroblastoma
• American Brain Tumor Association (ABTA)
• American Association of Neurological Surgeons (AANS) - Brain Tumors
• NCBI - StatPearls: Esthesioneuroblastoma