When would you consider adjuvant chemoradiation in a patient with esthesioneuroblastoma?

In both situations, I would give cisplatin concurrently with post-operative RT. One could make an argument for the combination regimen as this is a rare tumor lacking in randomized controlled phase III trials to establish standard of care. Multimodality management is extrapolated from HNSCC and neuroendocrine cancers. The literature consists mainly of retrospective case series that suggest that surgery + RT and chemotherapy (mostly single agent cisplatin) improve outcomes in advanced-stage disease. A microscopic positive margin at the primary is not unusual for these orbital and paranasal sinus cancers and if re-resection is not feasible, RT + radiosensitizing drug, e.g., cisplatin is appropriate. The presence of cervical lymph nodes and fu...