Nodal Recurrence in Olfactory Neuroblastoma

Olfactory neuroblastoma (ON), or esthesioneuroblastoma, classically arises from olfactory and neuroepithelium in the upper nasal valve, although it can originate anywhere in the nose. First described by Berger in 1924, it frequently involves the cribriform plate and olfactory bulb area and the anterior cranial fossa. Prognosis is good with 5-year survival nearing 80% with complete surgical resection (craniofacial resection or endoscopic) and postoperative radiotherapy. However, late recurrence, both local and regional, is not uncommon.

This study reviews a consecutive series of ONs treated predominately by the senior author at Charing Cross Hospital, London, between 2004 and 2012, with specific attention to regional recurrence (cervical and facial nodes).

All patients with histologically confirmed ON that were treated at Charing Cross Hospital between 2004 and 2012 were included in the study. There were 44 patients (16 women, 33%, and 28 men, 67%), age range from 27 to 72 years, mean 47 years. Regional recurrence, when the primary site was under control, occurred in 11 of the 44 cases. In 8 of these 11 cases, recurrence was to the cervical nodes (levels 1 to 3), and in 3 it was to the facial skin or the facial nodes.

It is not yet our practice to electively treat the neck in clinically negative ON patients, although it is noted that cervical lymph node metastasis in ON is reported in up to and sometimes in excess of 20% of cases in the literature. This clearly constitutes an important prognostic factor.

At the very least, patients with local control, who are surviving with increasing longevity, should have careful surveillance and close follow-up for regional recurrence.