RADIOTHERAPY FOR PERINEURAL INVASION IN CUTANEOUS HEAD AND NECK CARCINOMAS: TOWARD A RISK-ADAPTED TREATMENT APPROACH

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 cPN1 (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. (C) 2009 Wiley Periodicals, Inc. Head Neck 31: 604-610, 2009