Skin carcinoma of the head and neck with perineural invasion

Balamucki, Christopher J.; Mancuso, Anthony A.; Amdur, Robert J.; Kirwan, Jessica M.; Morris, Christopher G.; Flowers, Franklin P.; Stoer, Charles B.; Cognetta, Armand B.; Mendenhall, William M.

doi:10.1016/j.amjoto.2011.11.004

« BackAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery

Article in Press

Skin carcinoma of the head and neck with perineural invasion☆☆☆

Christopher J. Balamucki, MD
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
Anthony A. Mancuso, MD
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
Robert J. Amdur, MD
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
Jessica M. Kirwan, MA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
Christopher G. Morris, MS
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
Franklin P. Flowers, MD
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
Charles B. Stoer, MD
- Department of Dematology, Serenola Plantation, Gainesville, FL, USA
Armand B. Cognetta, MD
- Dermatology Associates, Tallahassee, FL, USA
William M. Mendenhall, MD
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
- Corresponding author. 2000 SW Archer Rd. PO Box 100385 Gainesville, FL 32610-0385, USA. Tel.: +1 352 265 0287; fax: +1 352 265 7045.

Received 5 October 2011 published online 21 December 2011.
Corrected Proof

Abstract

Purpose

The aim of the study was to update the experience treating cutaneous squamous cell and basal cell carcinomas of the head and neck with incidental or clinical perineural invasion (PNI) with radiotherapy (RT).

Materials and methods

From 1965 to 2007, 216 patients received RT alone or with surgery and/or chemotherapy.

Results

The 5-year overall, cause-specific, and disease-free survivals for incidental and clinical PNIs were 55% vs 54%, 73% vs 64%, and 67% vs 51%. The 5-year local control, local-regional control, and freedom from distant metastases for incidental and clinical PNIs were 80% vs 54%, 70% vs 51%, and 90% vs 94%. On univariate and multivariate (P = .0038 and .0047) analyses, clinical PNI was a poor prognostic factor for local control. The rates of grade 3 or higher complication in the incidental and clinical PNI groups were 16% and 36%, respectively.

Conclusions

Radiotherapy plays a critical role in the treatment of this disease. Clinical PNI should be adequately irradiated to include the involved nerves to the skull base.