Mohs resection and postoperative radiotherapy for head and neck cancers with incidental perineural invasion

Kropp, L.; Balamucki, Christopher J.; Morris, Christopher G.; Kirwan, Jessica; Cognetta, Armand B.; Stoer, Charles B.; Mendenhall, William M.

doi:10.1016/j.amjoto.2012.12.017

Cited by 40 publications

(49 citation statements)

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“…10,21,24,27,28,30,31 The risk of local recurrence ranged from 13% to 23%, while the risk of nodal metastasis ranged from 9% to 17%. One study had no occurrences of local recurrence or nodal metastasis.…”

Section: Resultsmentioning

confidence: 99%

Clinical and Incidental Perineural Invasion of Cutaneous Squamous Cell Carcinoma

et al. 2017

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IMPORTANCE Perineural invasion (PNI) in cutaneous squamous cell carcinoma (CSCC) has been associated with an increased risk of poor outcomes. Patients with PNI may present with clinical symptoms and/or radiologic evidence of PNI (clinical PNI [CPNI]), yet most patients are asymptomatic and PNI is often found on histologic examination (incidental PNI [IPNI]). Evidence-based estimates of the risks of disease-related outcomes comparing IPNI and CPNI are limited in the dermatology literature.OBJECTIVES To review and synthesize outcomes data for patients with CSCC and CPNI or IPNI.DATA SOURCES A systematic review was conducted in MEDLINE and EMBASE for English-language articles published since inception to November 11, 2016.STUDY SELECTION All studies that reported a disease-related outcome (local recurrence, nodal metastasis, distant metastasis, or disease-specific death) of CSCCs with CPNI and IPNI were included.DATA EXTRACTION AND SYNTHESIS Articles were screened for eligibility, and any possible discrepancies in this screening were resolved. Data extracted included study characteristics, tumor characteristics, treatments performed, and disease-related outcomes. Overall risks of disease-related outcomes were generated by pooling patients from eligible studies. χ 2 Statistics and Fisher exact tests were used to evaluate differences in disease-related outcomes.MAIN OUTCOMES AND MEASURES Risks of disease-related outcomes and 5-year recurrence-free, disease-specific, and overall survival. RESULTS A total of 12 studies containing 241 patients with CPNI and 381 patients with IPNI were included in the systematic review and analysis. The overall risks of local recurrence and disease-specific death were significantly higher in patients with CSCC and CPNI compared with those with CSCC and IPNI (local recurrence, 37% vs 17%; P < .001; disease-specific death, 27% vs 6%; P < .001). The risks of nodal metastasis and distant metastasis did not differ significantly by PNI classification. Patients with CSCC and CPNI had poorer mean 5-year recurrence-free survival and disease-specific survival compared with patients with IPNI (recurrence-free survival, 61% vs 76%; P = .009; disease-specific survival, 70% vs 88%; P = .002). CONCLUSIONS AND RELEVANCEPatients with CSCC and CPNI are at an increased risk of local recurrence and disease-specific death compared with patients with CSCC and IPNI and have a 30% risk of death. Patients with PNI may benefit from increased long-term surveillance. Further studies are needed to establish standardized guidelines on follow-up and dermatologic surveillance in this high-risk patient population.

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Section: Resultsmentioning

confidence: 99%

Clinical and Incidental Perineural Invasion of Cutaneous Squamous Cell Carcinoma

et al. 2017

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“…Previous studies have confirmed that patients with PNI whose nodes are clinically and instrumentally negative, exhibit an increased rate of spread to the regional nodes (1,2,16,(21)(22)(23)(24). In consequence, these patients should be subjected to elective neck dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Considering the impact on prognosis, the presence of PNI affects the therapeutic options and the decision making process in patients with laryngeal cancer. In this regard, adjuvant radio-chemotherapy has been demonstrated to result in a better outcome in those patients presenting with PNI, in terms of recurrence, local control of the disease, overall survival and disease-free survival rates (2,14,16,21).…”

Section: Discussionmentioning

confidence: 99%

Role of perineural invasion as a prognostic factor in laryngeal cancer

et al. 2016

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Abstract. The diffusion of laryngeal cancer cells in the perineural space is a parameter associated with a negative prognosis, high loco-regional recurrence and low disease-free survival rates. The spread of tumor cells on the perineural sheath highlights the histopathological and clinically aggressive behavior of this type of tumor, which may extend proximally or distally in the nerve for >10 cm. Therefore, the surgical resection margin is generally insufficient to treat patients with laryngeal cancer presenting with perineural invasion (PNI) with surgery alone. In PNI, the minor laryngeal nerves are frequently involved, rather than the superior and inferior laryngeal nerves. The aim of the present study was: i) To evaluate the prognostic importance of PNI; ii) to correlate the rate of infiltration with factors associated with the tumor, including histotype, site and tumor-node-metastasis stage, and with the type of surgery (total or partial laryngectomy); and iii) to evaluate the rate of disease-free survival according to the outcome of combined surgery and radiotherapy (RT) treatment, by means of retrospective analysis. The results of the present study highlighted the importance of performing a closer clinical and instrumental follow-up in patients with laryngeal cancer whose histopathological examination is positive for PNI. In such cases, it is important to complement the surgical therapeutic treatment with adjuvant RT. IntroductionPerineural invasion (PNI), also known as neurotropic carcinomatous spread, is a process predominantly characterized by neoplastic invasion of the nerves. PNI may also occur in the absence of lymphatic or vascular invasion (1-5).In PNI, the propagation of neoplastic cells to the primitive site of the tumor does not occur via lymphatic dissemination, but through molecular mediators that guide these cells during the invasion of the nerve sheath (6). The definition of PNI was first proposed in a study by Batsakis (3), according to which, PNI was 'a tumor cell invasion in, around and through the nerve'. Following multiple modifications, PNI is currently defined as 'the presence of tumor cells in the 3 layers of the nerve sheath' or 'in close proximity to nerve, involving at least 33% of its entire circumference'; below this cut-off, focal abutment rather than PNI should be considered (1,6).The incidence of PNI has been reported to vary from 6 to 50% for head and neck cancer, and <80% for squamocellular carcinoma. PNI is an independent negative prognostic factor associated with a lesser loco-regional control of the disease and poor survival in patients with laryngeal cancer (1,2,(6)(7)(8)(9)(10)(11)(12)(13)(14). The aim of the present study was: i) To evaluate the prognostic importance and incidence of PNI; ii) to correlate the infiltration rate with factors associated to the tumor, including histotype, site and tumor-node-metastasis stage (TNM), and with the type of surgery (total or partial laryngectomy); iii) to evaluate the disease-free survival rate according to the outcome of com...

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“…The positive impact of radiotherapy on local control and disease-specific survival in the management of SCCs with perineural invasion has been demonstrated in several retrospective studies. 6,8 In the context of this literature, our data indicate that resection can be considered in these circumstances if it can be performed safely in conjunction with postoperative radiotherapy. Furthermore, this is important in patients presenting with local progression after initial resection; the previous administration of radiotherapy limits the indications for surgery in situations of salvage treatment.…”

Section: Impact Of Multimodality Treatment Of Nmscs On Pfs and Osmentioning

confidence: 98%

Nonmelanoma cutaneous cancers involving the skull base: outcomes of aggressive multimodal management

Raza¹,

Ramakrishna²,

Weber

et al. 2015

JNS

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R epResenting the most common human neoplasm, skin cancers occur in the head and neck region in nearly 90% of cases due to sun exposure. Of these, nonmelanoma skin cancers (NMSCs) pose a unique set of challenges. Basal cell carcinoma (BCC) is the most common malignancy in this area, with squamous cell carcinoma (SCC) second in frequency. BCC is characterized by its propensity for local aggressive growth and the capacity to reach large sizes (greater than 2 cm). SCC is the second most common cutaneous malignancy and is differentiated from BCC by its tendency to spread to regional lymph nodes (15% in tumors greater than 2 cm) and for perineural invasion (2%-15%). While considered a histological subtype of BCC, basosquamous carcinoma (BSCC) is abbreviatioNs BCC = basal cell carcinoma; BSCC = basosquamous cell carcinoma; CN = cranial nerve; MDACC = MD Anderson Cancer Center; NMSC = nonmelanoma skin cancer; OS = overall survival; PFS = progression-free survival; SCC = squamous cell carcinoma. obJect A relative paucity of information exists regarding outcomes from craniofacial resection for advanced nonmelanoma skin cancers involving the skull base. In light of advances in surgical technique and adjuvant therapy protocols, the authors reviewed their surgical experience to determine disease control rates, overall survival (OS), morbidity, and mortality. methods A retrospective review of 24 patients with nonmelanoma cutaneous cancers with skull base involvement treated with craniofacial resection at The University of Texas MD Anderson Cancer Center from 1994 to 2012 was performed. Of these patients, 19 (79%) had squamous cell carcinoma (SCC), 4 (17%) had basosquamous carcinoma (BSCC), and 1 patient (4%) had adenocarcinoma. Factors as assessed were prior treatment, TNM staging, tumor involvement, extent of intracranial extension, margin status, postoperative complications, recurrence, disease status at last follow-up, and long-term survival. The majority of tumors were T4 (67%) according to the TNM classification; perineural extension was noted in 58%, cavernous sinus involvement in 25%, and dural involvement in 29%. results Postoperative complications occurred in 4 patients (17%) including 1 death. Kaplan-Meier estimates were calculated for OS and progression-free survival (PFS). Median OS was 43.2 months with an 82% 1-year OS and 37% 5-year OS; the median PFS was 91.2 months. Margin status was positively associated with median OS in SCC (91 months [for negative margins] vs 57 months, p = 0.8) and in BSCC (23.7 vs 3.2 months, p < 0.05). Postoperative radiotherapy was associated with improved median OS (43.2 vs 22 months, p = 0.6). Brain involvement was uniformly fatal after 1 year, while cavernous sinus involvement (31 vs 43 months, p = 0.82), perineural disease (31 vs 54 months, p = 0.30), and T4 stage (22 vs 91.2 months, p = 0.09) were associated with worsened OS. Similar associations were found with median PFS. coNclusioNs Aggressive multimodality management with surgery and postoperative radiotherapy can positively...

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Mohs resection and postoperative radiotherapy for head and neck cancers with incidental perineural invasion

Cited by 40 publications

References 23 publications

Clinical and Incidental Perineural Invasion of Cutaneous Squamous Cell Carcinoma

Clinical and Incidental Perineural Invasion of Cutaneous Squamous Cell Carcinoma

Role of perineural invasion as a prognostic factor in laryngeal cancer

Nonmelanoma cutaneous cancers involving the skull base: outcomes of aggressive multimodal management

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