Revisiting intra-arterial chemotherapy-palliative utility in a case of recurrent esthesioneuroblastoma and literature review.
Bernard Okai, Jaims Lim, Vinay Jaikumar et al.
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Case in brief
An elderly man with esthesioneuroblastoma previously treated by resection and radiation developed recurrence 28 years later, with visual loss and headaches. Multiple stereotactic radiosurgery sessions over two years were ineffective. Angiography identified the bilateral internal maxillary arteries as the main tumor feeders, and carboplatin was delivered intra-arterially through these vessels in two stages one month apart. The procedures were well tolerated, with no complications. At two-month follow-up, symptoms had improved and imaging showed stable tumor; the patient chose palliative care.
What made this case unusual
The recurrence appeared 28 years after initial treatment, and its main feeders were the bilateral internal maxillary arteries, enabling superselective intra-arterial carboplatin delivery after radiosurgery had been ineffective.
Diagnostic / clinical pearl
For recurrent esthesioneuroblastoma considered for intra-arterial chemotherapy, identifying the tumor’s arterial feeders can guide superselective delivery; in this case, the bilateral internal maxillary arteries were the primary feeders.
Why it matters
The case and the authors’ review describe intra-arterial chemotherapy as a potential option for primary or recurrent esthesioneuroblastoma, while the limited reported experience does not establish its efficacy.