Esthesioneuroblastoma: the decisions you may face
5 treatment settings, 4 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Diagnosis and staging
Endoscopic biopsy with immunohistochemistry, MRI and CT of the sinuses and skull base, neck imaging, DOTATATE PET where available.
Histopathology means looking at cancer cells under a microscope, and immunohistochemistry stains them for specific proteins. Together they are still the foundation of every diagnosis.
- Cheap, fast, universal
- Companion diagnostic for most targeted drugs
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
- No ionising radiation
- Best soft-tissue and brain imaging
- Functional sequences (diffusion, perfusion)
A CT scan is a fast 3D X-ray that shows the size and shape of tumours and whether they have spread.
- Fast, ubiquitous
- Sub-millimetre resolution
- Standard for RECIST response
A PET scan using a radioactive hormone mimic that lights up neuroendocrine tumours and shows whether the matching radioactive treatment will work.
- Whole-body receptor map
- Theranostic gatekeeper for 177Lu-DOTATATE
- Changes management in ~40% of patients versus conventional imaging
PET and CT in one machine, so hot spots on the PET are pinned to exact locations on the CT.
- Anatomy plus biology
- Standard for lymphoma, lung, melanoma, head and neck staging
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Subjective scoring
- Single-site sampling misses heterogeneity
- Slow and expensive
- Motion artefacts
- Gadolinium concerns in renal impairment
- Anatomic only; cannot distinguish scar from live tumour
- Radiation dose
- Poor for brain, marrow, and small peritoneal disease
- Physiologic uptake in pancreas uncinate, spleen, pituitary
- Poor sensitivity in SSTR-negative high-grade disease
- 68Ga generator supply and short half-life
- CT radiation added to PET dose
- Between Histopathology & immunohistochemistry, MRI, CT (computed tomography) and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers (ethmoid and maxillary sinus tumours)), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (diagnosis and staging), which of the standard options do you recommend and why?Why: Guideline options include: Endoscopic biopsy with immunohistochemistry, MRI and CT of the sinuses and skull base, neck imaging, DOTATATE PET where available.
Add these to your appointment list, or take the full question set for this cancer.
Resectable disease
Endoscopic endonasal or craniofacial resection with skull base reconstruction by a skull base team, followed by postoperative radiotherapy (intensity-modulated or proton) for nearly all patients.
Surgeons operate through small incisions using robotic arms with tremor-free precision and 3D vision.
- Precision, shorter stay
- Enables complex minimally invasive resections
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
Radiation using protons, which stop inside the tumour instead of passing through, so tissue behind it gets no dose.
- No exit dose; lower integral dose
- Reduced second cancers in children
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Cost
- Loss of haptic feedback
- Not superior for every indication
- Low-dose bath to normal tissue
- Motion management
- Cost
- Range uncertainty
- Limited randomised evidence in adults
- Between Robotic & minimally invasive surgery, IMRT / IGRT (modern external beam) and Proton therapy, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers (ethmoid and maxillary sinus tumours)), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (resectable disease), which of the standard options do you recommend and why?Why: Guideline options include: Endoscopic endonasal or craniofacial resection with skull base reconstruction by a skull base team, followed by postoperative radiotherapy (intensity-modulated or proton) for nearly all patients.
Add these to your appointment list, or take the full question set for this cancer.
High-grade or advanced disease (Hyams III to IV, Kadish C to D)
Induction cisplatin and etoposide, then surgery and radiotherapy or definitive chemoradiotherapy; elective neck irradiation considered.
Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.
Etoposide is a chemotherapy from the mayapple plant, essential to curing testicular cancer (BEP), treating small-cell lung cancer, lymphomas, childhood sarcomas and leukaemias, and used in transplant conditioning.
Platinum plus etoposide has been the chemotherapy backbone of small-cell lung cancer for over 40 years, and is now given with immunotherapy.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
- Conformal dose, fewer side effects
- Hypofractionation saves visits
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
- Reduce to 75% for CrCl 15-50.
- Low-dose bath to normal tissue
- Motion management
- Between Cisplatin, Etoposide, Platinum + etoposide (EP / CE) and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers (ethmoid and maxillary sinus tumours)), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (high-grade or advanced disease (hyams iii to iv, kadish c to d)), which of the standard options do you recommend and why?Why: Guideline options include: Induction cisplatin and etoposide, then surgery and radiotherapy or definitive chemoradiotherapy; elective neck irradiation considered.
- Am I a candidate for Cisplatin, Etoposide, Platinum + etoposide (EP / CE), and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.
Recurrent or metastatic disease
Repeat surgery or re-irradiation for local relapse; lutetium-177 dotatate for somatostatin-receptor-positive disease; platinum-etoposide or temozolomide; trials.
Lutetium-177 dotatate was the first modern radioligand therapy (2018), for neuroendocrine tumours, and is now used in first line.
A radioactive version of the hormone mimic used for the scan; it homes to neuroendocrine tumour cells and irradiates them from inside.
- Systemic, receptor-targeted
- Response and quality-of-life benefit
- Imaging selects and monitors
Platinum plus etoposide has been the chemotherapy backbone of small-cell lung cancer for over 40 years, and is now given with immunotherapy.
The only chemotherapy proven to extend life in glioblastoma, given during and after radiation. It works best when the tumour has switched off a repair gene called MGMT.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Lymphopenia · NETTER-1; grade 3-4 rates | - | 44% |
| GGT increased · NETTER-1; grade 3-4 rates | - | 20% |
| Vomiting · NETTER-1; grade 3-4 rates | - | 7% |
| Nausea · NETTER-1; grade 3-4 rates | - | 5% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
- Myelosuppression, rare MDS/AML (~2-3%)
- Renal dose
- Not curative; retreatment data limited
- Take on an empty stomach or at bedtime to reduce nausea; PJP prophylaxis during concurrent chemoradiation.
- Between Lutetium-177 dotatate, Peptide receptor radionuclide therapy (PRRT), Platinum + etoposide (EP / CE) and the other options, which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- Which side effects of Lutetium-177 dotatate are most likely for me, which are reversible, and which would make us stop?Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers (ethmoid and maxillary sinus tumours)), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (recurrent or metastatic disease), which of the standard options do you recommend and why?Why: Guideline options include: Repeat surgery or re-irradiation for local relapse; lutetium-177 dotatate for somatostatin-receptor-positive disease; platinum-etoposide or temozolomide; trials.
- Am I a candidate for Lutetium-177 dotatate, Platinum + etoposide (EP / CE), Temozolomide, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.
Follow-up
MRI surveillance indefinitely because of late relapse; management of anosmia, cerebrospinal fluid leak and visual effects.
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
- No ionising radiation
- Best soft-tissue and brain imaging
- Functional sequences (diffusion, perfusion)
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Slow and expensive
- Motion artefacts
- Gadolinium concerns in renal impairment
- Is MRI the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?Why: A single standard does not mean a single choice; timing and trials are decisions too.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- Does your recommendation follow the current guideline (NCCN Guidelines: Head and Neck Cancers (ethmoid and maxillary sinus tumours)), and if it departs from it, why?Why: Departures from guidelines are sometimes right for an individual; they should be explained.
- For my situation (follow-up), which of the standard options do you recommend and why?Why: Guideline options include: MRI surveillance indefinitely because of late relapse; management of anosmia, cerebrospinal fluid leak and visual effects.
Add these to your appointment list, or take the full question set for this cancer.