Treatment of esthesioneuroblastoma with chemotherapy: a report of two cases

Esthesioneuroblastoma is an uncommon tumor arising from the olfactory epithelium within the nasopharynx. Conventional treatment consists of surgical resection and irradiation. The use of chemotherapy in limited responses has been reported using cyclophosphamide, thio-TEPA, nitrogen mustard, vincristine, doxorubicin, and chlorambucil as single drugs or in various combinations. Two cases are presented in which neurologic involvement prompted the application of intraventricular methotrexate by an implantable constant infusion drug delivery system in one patient and intra-arterial cis-platinum in combination with intravenous 5-fluorocytosine in a second patient. The tumor of the first patient responded to irradiation followed by methotrexate for four years. The second patient experienced a brief response to the combined chemotherapy following surgery for a recurrent esthesioneuroblastoma. A brief review of the literature regarding chemotherapy and the aggressive form of esthesioneuroblastoma is presented.