Olfactory neuroblastoma, also known as Esthesioneuroblastoma (ENB), was first named by foreign scholars in 1924 and is a very rare malignant tumor originating from the nasal cavity, accounting for 1-6% of all nasal tumors and less than 1% of all human tumors. The tumor originates from the olfactory mucosa of the sieve plate and often invades the paranasal sinuses, orbit and skull base. Common symptoms include nasal congestion, epistaxis, runny nose, pain in the paranasal sinus region, visual changes, facial numbness, or the presence of a neck mass, and the disease is usually locally advanced at the time of detection, with a 17-27% incidence of cervical lymph node metastasis and a 10-40% incidence of distant metastasis. In addition to CT, MRI is a useful staging tool that provides a good distinction between tumor and paranasal sinusitis. Factors affecting the prognosis of ENB include age, stage, gender, and pathological grade. Patients older than 50 years have a worse prognosis than female patients, and those with positive lymph nodes have a worse prognosis than those with negative lymph nodes (5-year survival: 29% vs. 64%). Pathologic grading is also an important prognostic factor. Hyams grading is based on well-defined histologic features such as lobular structure, nerve fiber background, chrysanthemum shape, nuclear schwannoma, mitosis, apoptosis, and tumor calcification. Significantly worse prognosis has been reported in patients with high grading than in patients with low grading (5-year survival rate: 36% vs. 81%). In the literature, the local area failure rate for ENB after radical treatment is reported to be 24%-75%, and the 5-year survival rate is 60%-78%. In one report, the 5-year local control rate was 87.4% in patients who received surgery + radiotherapy compared to 51.2% in patients who received surgery alone, and in patients who experienced local area failure, the site of failure was often the septal sinus and orbit, and patients could also develop liver or brain tissue Metastases. There is no general agreement in the literature regarding the different treatment approaches, but there is more agreement that combined treatment is preferable to single-means treatment. In one report, the recurrence-free survival rate for surgery combined with postoperative adjuvant radiotherapy was 92%, compared with 14% for surgery alone and 40% for radiotherapy alone. Surgery combined with radiotherapy improved survival by 20%. For patients staged Kadesh A and B, most experts prefer surgery combined with radiotherapy, while for patients with stage C, additional chemotherapy is often required in addition to the above regimen. Radiotherapy techniques for ENB have changed with the times, from the initial intracranial radium implantation, cobalt 60, and low-energy radiation therapy to the current proton or photon radiation exposure. The conventional radiotherapy technique consists of three-field irradiation: an anterior field and two lateral wedge fields, and the postoperative radiotherapy dose is usually 50-65 Gy. Due to the proximity of the tumor target area to many vital tissues and organs such as intraorbital structures, it is difficult to safely project an effective radiotherapy dose to the tumor site or postoperative tumor bed. If IMRT or stereotactic radiotherapy is used, it is possible to give a higher dose to the tumor or tumor bed while ensuring that the dose to vital organs is below the tolerated dose, thus improving the local control rate and survival rate of the tumor. Currently, preoperative radiotherapy is also carried out in a few units. Polin et al. reported the results of a study of 34 patients with pathologically confirmed ENB treated by preoperative radiotherapy ± chemotherapy followed by surgery, with 5-year and 10-year survival rates of 81% and 54.5%, respectively. The results of this study are encouraging because 23 of these patients were Kadesh stage C. Results from the Meta-analysis showed a 5-year overall survival rate of 45% and a 5-year disease-free survival rate of 41%.