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Treatment of esthesioneuroblastoma: A double approach?
Neurochirurgie 61 (2015) 54
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Letter to the editor Treatment of esthesioneuroblastoma: A double approach? Traitement des esthésioneuroblastomes : une double approche ?
a r t i c l e
i n f o
Keywords: Esthesioneuroblastoma Oncology Skull base
Dear Editor, In response to the excellent paper of König et al., published in the issue Neurochirurgie 2014;60:151–7, I want to thank the authors for their review of a cohort of 11 patients treated for an esthesioneuroblastoma. To manage these patients, they proposed a craniofacial resection (CFR) in 3 patients, a CFR followed by radiotherapy (RT) in 7 and 1 received a neoadjuvant and adjuvant RT. The quality of resection was controlled by a careful analysis of the marginal resection requiring second-look surgery in 5 patients. This team reported excellent results: the overall survival was 100% at 1 year and 80% at 5 years. A discussion at a high level was focused on the treatment modalities: place of radiotherapy, role of chemotherapy and the results in the literature in terms of a disease free survival rate. Permit me to offer 2 comments: • regarding the surgical technique, the CFR was presented as the gold standard but figure 1 showed a lesion invading the dura mater of the anterior floor of the cranial base. The microsurgical resection of the CRF was clearly detailed in the paper. An endocranial approach allows a complete resection of the dura mater and a good optic view to perform the ethmoidectomy. The head and neck surgeon made a modified lateral rhinotomy incision in the
DOI of original article: http://dx.doi.org/10.1016/j.neuchi.2014.03.007. http://dx.doi.org/10.1016/j.neuchi.2014.09.004 0028-3770/© 2014 Elsevier Masson SAS. All rights reserved.
skin. This last step could be replaced by a purely endoscopic technique via a transnasal approach. The combined work permitted to perform a total ethmoidectomy in several tumors without any facial incision. What do you think about this combined approach: endocranial and purely endoscopic to perform a complete ethmoidectomy? • I agree with the authors as regards the aggressive approach in case of resectable local or regional recurrence, with a condition for absence of systemic dissemination. This paper, which focused on a difficult topic reaching a high level, is important to read. Thanks a lot to Professor Meling and his team for choosing our journal for this important article. Disclosure of interest The author declares that he has no conflicts of interest concerning this article. F. Proust a,∗,b Department of Neurosurgery, Rouen University Hospital – Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex, France b INSERM U982, DC2N-Neuronal and Neuroendocrine Communication and Differentiation, Faculty of Sciences, Rouen University, 76821 Mont-Saint-Aignan, France a
∗ Correspondence. E-mail address: [email protected]
Received 8 September 2014 Received in revised form 17 September 2014 Accepted 19 September 2014 Available online 13 January 2015
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
Letter to the editor Treatment of esthesioneuroblastoma: A double approach? Traitement des esthésioneuroblastomes : une double approche ?
a r t i c l e
i n f o
Keywords: Esthesioneuroblastoma Oncology Skull base
Dear Editor, In response to the excellent paper of König et al., published in the issue Neurochirurgie 2014;60:151–7, I want to thank the authors for their review of a cohort of 11 patients treated for an esthesioneuroblastoma. To manage these patients, they proposed a craniofacial resection (CFR) in 3 patients, a CFR followed by radiotherapy (RT) in 7 and 1 received a neoadjuvant and adjuvant RT. The quality of resection was controlled by a careful analysis of the marginal resection requiring second-look surgery in 5 patients. This team reported excellent results: the overall survival was 100% at 1 year and 80% at 5 years. A discussion at a high level was focused on the treatment modalities: place of radiotherapy, role of chemotherapy and the results in the literature in terms of a disease free survival rate. Permit me to offer 2 comments: • regarding the surgical technique, the CFR was presented as the gold standard but figure 1 showed a lesion invading the dura mater of the anterior floor of the cranial base. The microsurgical resection of the CRF was clearly detailed in the paper. An endocranial approach allows a complete resection of the dura mater and a good optic view to perform the ethmoidectomy. The head and neck surgeon made a modified lateral rhinotomy incision in the
DOI of original article: http://dx.doi.org/10.1016/j.neuchi.2014.03.007. http://dx.doi.org/10.1016/j.neuchi.2014.09.004 0028-3770/© 2014 Elsevier Masson SAS. All rights reserved.
skin. This last step could be replaced by a purely endoscopic technique via a transnasal approach. The combined work permitted to perform a total ethmoidectomy in several tumors without any facial incision. What do you think about this combined approach: endocranial and purely endoscopic to perform a complete ethmoidectomy? • I agree with the authors as regards the aggressive approach in case of resectable local or regional recurrence, with a condition for absence of systemic dissemination. This paper, which focused on a difficult topic reaching a high level, is important to read. Thanks a lot to Professor Meling and his team for choosing our journal for this important article. Disclosure of interest The author declares that he has no conflicts of interest concerning this article. F. Proust a,∗,b Department of Neurosurgery, Rouen University Hospital – Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex, France b INSERM U982, DC2N-Neuronal and Neuroendocrine Communication and Differentiation, Faculty of Sciences, Rouen University, 76821 Mont-Saint-Aignan, France a
∗ Correspondence. E-mail address: [email protected]
Received 8 September 2014 Received in revised form 17 September 2014 Accepted 19 September 2014 Available online 13 January 2015