Combination chemotherapy (cyclophosphamide, doxorubicin, and vincristine with continuous‐infusion cisplatin and etoposide) and radiotherapy with stem cell support can be beneficial for adolescents and adults with estheisoneuroblastoma

• Published in: Cancer Vol. 101; no. 6; pp. 1437 - 1444
• Main Authors: Mishima, Yuko, Nagasaki, Eijiro, Terui, Yasuhito, Irie, Tetsuya, Takahashi, Shunji, Ito, Yoshinori, Oguchi, Masahiko, Kawabata, Kazuyoshi, Kamata, Shinetsu, Hatake, Kiyohiko
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15-09-2004; Wiley-Liss
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cisplatin - administration & dosage; combined chemotherapy and radiotherapy; Combined Modality Therapy; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; esthesioneuroblastoma; Esthesioneuroblastoma, Olfactory - therapy; Etoposide - administration & dosage; Female; Hematopoietic Stem Cell Transplantation; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Nose Neoplasms - therapy; peripheral blood stem cell transplantation; Retrospective Studies; toxicity; Tumors; Vincristine - administration & dosage; Antineoplastic agent; combined chemotherapy and radiotherapy; Toxicity; Stem cell; Hematopoietic cell; Homograft; peripheral blood stem cell transplantation; Doxorubicin; Blood; Alkaloid; Isomerases; Cancerology; esthesioneuroblastoma; Graft; Adult; Antimitotic; Platinum II Complexes; Human; DNA topoisomerase (ATP-hydrolysing); Enzyme; Enzyme inhibitor; Etoposide; Radiotherapy; Vincristine; Cisplatin; Podophyllotoxine derivatives; Alkylating agent; Oxazaphosphinane derivatives; Cyclophosphamide; Perfusion; Nitrogen mustard; Adolescent; Anthracyclins; Combined treatment
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.20471

BACKGROUND
Adolescent‐onset and adult‐onset esthesioneuroblastoma is a rare disease and is considered incurable. In many patients, local resection and radiation are chosen as clinical therapy with or without chemotherapy. It was reported previously that local resection and radiotherapy led to temporary remission and, in many patients, recurrent disease. Although combination with chemotherapy has been regarded as promising, an effective regimen has not been established. In the current study, the authors investigated the effect and tolerability of the combination of chemotherapy, radiotherapy, and peripheral blood stem cell transplantation (PBSCT).
METHODS
The study population included 12 patients with adolescent‐onset and adult‐onset esthesioneuroblastoma classified as Kadish Stage A–D. The patients received two cycles of combination chemotherapy, which consisted of cyclophosphamide, doxorubicin, and vincristine (CAD) with continuous‐infusion cisplatin and etoposide (CVP). This was combined with radiotherapy with or without PBSCT.
RESULTS
Nine of 12 patients (75%) obtained more than a partial response after only 2 cycles of chemotherapy. After radiation with or without PBSCT, six patients obtained a complete remission (CR). The longest survival was > 3 years. All patients who underwent PBSCT obtained a CR. The most severe side effects were loss of sodium and potassium induced by cisplatin‐related renal tubular distress. Those abnormalities were temporary, and all patients recovered.
CONCLUSIONS
The chemotherapy regimen with CADO and CVP does not require continuation for a long time and is very effective and tolerable for patients with adolescent‐onset and adult‐onset esthesioneuroblastoma. The combination with radiotherapy and PBSCT may lead to a CR without facial disfigurement. In this report, the authors discuss the feasibility and efficacy of this multidisciplinary approach. Cancer 2004. © 2004 American Cancer Society.
A combined chemotherapy regimen of cyclophosphamide, doxorubicin, and vincristine plus continuous‐infusion cisplatin and etoposide was very effective for adolescent‐onset and adult‐onset esthesioneuroblastoma. The combination of chemotherapy with radiotherapy and peripheral blood stem cell transplantation is a feasible multidisciplinary approach and may lead to complete remission without facial disfigurement.