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Radiotherapy for perineural invasion in cutaneous head and neck carcinomas: Toward a risk‐adapted treatment approach
Author(s) -
Jackson James E.,
Dickie Graeme J.,
Wiltshire Kirsty L.,
Keller Jacqui,
Tripcony Lee,
Poulsen Michael G.,
Hughes Mary,
Allison Roger W.,
Martin Jarad M.
Publication year - 2009
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.20991
Subject(s) - medicine , perineural invasion , head and neck , histology , radiation therapy , head and neck cancer , overall survival , oncology , surgery , cancer
Background We retrospectively reviewed outcomes in patients treated with radiotherapy (RT) for cutaneous head and neck carcinoma with perineural invasion (PNI), with the aim of developing risk‐adapted treatment guidelines. Methods A total of 118 patients were treated with RT between April 1992 and July 2000. Ninety‐seven patients had PNI discovered through histology (pPNI) and 21 patients had symptoms/signs of PNI (cPNI). All received RT (median dose, 55 Gy; range, 17–74): 114 postoperatively and 4 definitively. Median follow‐up was 84 months (range, 4–201). Results The 5‐year local control (LC) rates were 90% with pPNI and 57% with cPNI ( p < .0001). The pPNI and cPNI groups also differed in relapse‐free survival (76% vs 46%, p = .003), disease‐specific survival (90% vs 76%, p = .002), and overall survival (69% vs 57%, p = .03). pPNI patients with BCC histology ( n = 42) had better LC (97% vs 84%, p = .02) than pPNI SCC ( n = 55). Conclusion Surgery plus RT provides a high rate of LC in patients with pPNI, particularly those with BCC. Therapeutic improvements are needed for patients with cPNI. © 2009 Wiley Periodicals, Inc. Head Neck, 2009