Proton Beam Radiotherapy versus Intensity-Modulated Radiotherapy in Olfactory Neuroblastoma: A Multi-institutional Propensity-Matched Study
Bibliographic record
Abstract
Introduction: Olfactory neuroblastoma (ONB) is a rare sinonasal malignancy that can present with locally advanced disease. Previous studies have demonstrated that post-resection radiotherapy can provide a survival and recurrence advantage in patients with ONB, particularly in the setting of higher stage and histologic grade. Two of the main methods of radiotherapy delivery include proton beam radiotherapy (PBRT) and intensity-modulated radiotherapy (IMRT). The differences in the effectiveness of these two methods have been studied in other fields including head and neck cancer; however, no studies comparing the two methods have been studied for patients with ONB. Therefore, the purpose of this study is to compare the differences in survival and recurrence for ONB patients being treated with PBRT and IMRT using propensity-matched cohorts from a multi-institutional database. Methods: This modern-era multicenter data originated from the retrospective review of electronic health records (EHRs) of all patients who presented with ONB between 2005 and 2021 at nine academic, tertiary care centers within North America. Only patients treated with either IMRT or PBRT were included in the study. Clinicopathologic features including treatment modalities, pathologic and MRI imaging status, modified Kadish staging systems, Hyams grading, margin status, and follow-up time. Outcomes collected for analysis included local recurrence-free survival (Local-RFS), regional recurrence-free survival (Regional-RFS), total recurrence-free survival (RFS), and overall surval (OS). Propensity matching of age, gender, Hyams grade, modified Kadish staging, resection margin status, and chemotherapy use ( Table 1 ) between treatment modalities was confirmed with chi-square and Fisher’s exact tests. Statistical analysis was done using Kaplan–Meier curves and log-rank tests. Results: Of the 205 ONB patients treated with surgical resection and adjuvant radiation therapy for curative intent, 18 patients were identified to receive PBRT. This cohort was then matched to the current standard of IMRT at a 1:1 ratio for a total of 36 patients in this multi-institutional study. The average follow-up time for IMRT was 71.7 (SD, 52.9) months and for PBRT was 53.2 (SD, 39.5) months ( p = 0.24). For IMRT, the 5-year local-RFS, Regional-RFS, RFS and 5-year OS were 69.2, 92.9, 64.8, and 80.8%, respectively. For PBRT, the 5-year local-RFS, Regional-RFS, RFS and 5-year OS were 90.9, 79.7, 56.7, and 85.7%, respectively. Similarly, there were no differences in local RFS ( p = 0.34, [ Fig. 1 ]), regional RFS ( p = 0.29, [ Fig. 2 ]), total recurrence-free survival ( p = 0.4, [ Fig. 3 ]), and overall survival ( p = 0.52, [ Fig. 4 ]) between patients treated with PBRT and IMRT. Fig. 1 Fig. 2 Fig. 3 Fig. 4 Conclusion: This study is the first to compare the effectiveness of IMRT and PBRT in patients with advanced olfactory neuroblastoma. These findings support that IMRT and PBRT are comparable in overall survival and recurrence-free survival as treatment methods for advanced stage/grade olfactory neuroblastoma. Future investigations comparing quality-of-life outcomes between these radiotherapy modalities are needed to better delineate patient-centered treatments for ONB. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".