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Ryan MP, Winsett FT, Armenta AM, Goodwin BP, Wagner RF. Lymphovascular Invasion in Cutaneous Squamous Cell Carcinoma. Dermatol Surg 2024:00042728-990000000-00754. [PMID: 38603804 DOI: 10.1097/dss.0000000000004187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Although there is a large body of literature regarding risk stratification and outcomes for perineural invasion (PNI) in cutaneous squamous cell carcinoma (cSCC), there is a relative paucity of studies exploring the role of lymphovascular invasion (LVI) in cSCC and a lack of clear evidence-based guidelines for how to manage patients with these tumors. OBJECTIVE This article is intended to review the available literature regarding LVI in cSCC and formulate evidence-based recommendations for clinical management. METHODS AND MATERIALS A literature review was conducted using PubMed to find relevant articles relating to outcomes and management of primary cSCC with LVI. RESULTS The available literature suggests that LVI is a major risk factor for poor outcomes and increased morbidity and mortality in cSCC. CONCLUSION Lymphovascular invasion is a very high-risk feature that should place these tumors in the highest-risk category, and management of these tumors should be similar to that of squamous cell carcinoma with PNI.
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Affiliation(s)
- Michael P Ryan
- Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Frank T Winsett
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | - Andrew M Armenta
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | - Brandon P Goodwin
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
| | - Richard F Wagner
- Department of Dermatology, University of Texas Medical Branch, Galveston, Texas
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2
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Schachtel MJ, Panizza BJ, Gandhi M. Evaluation of facial nerve perineural spread from cutaneous squamous cell carcinoma using 3T MR neurography. J Med Imaging Radiat Oncol 2024; 68:41-49. [PMID: 37742295 DOI: 10.1111/1754-9485.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Perineural spread (PNS) is a rare but potentially fatal consequence of cutaneous squamous cell carcinoma (cSCC) of the head and neck. We aimed to evaluate the accuracy of 3T MR neurography in detecting and defining the extent of facial nerve (VII) PNS from cSCC, and highlight characteristic radiological features in peripheral branches to improve early diagnosis. METHODS Single-institution retrospective review of 38 patients with clinical, radiological, and/or histopathological findings consistent with VII PNS from cSCC who underwent pre-operative 3T MR neurography. RESULTS Compared to histopathology (gold standard), 3T MR neurography had a sensitivity of 89% and positive predictive value of 97%. In true-positive cases (n = 33), zonal extent was correctly identified in 100%. Seventy-nine% had simultaneous trigeminal nerve (V) PNS, mostly involving the auriculotemporal branch of the mandibular nerve (64%). When the causative lesion was absent (n = 23), the extra-temporal VII demonstrated asymmetrical enhancement alone (n = 6), bulky expansion (n = 8), or extra-neural spread (n = 9). Peripheral VII branch involvement, particularly the buccal and zygomatic, was readily identified using known anatomical landmarks. CONCLUSION 3T MR neurography is highly accurate in evaluating VII PNS from cSCC, and thus should be specifically requested by physicians if suspicious for disease. Coexistent V PNS was common, highlighting the need to examine V branches to allow complete treatment planning. The unique radiological patterns identified showcases disease progression. As early detection improves patient outcomes, the radiologist must look for peripheral VII involvement in specific anatomical areas, which is within the capabilities of 3T MR neurography.
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Affiliation(s)
- Michael Jc Schachtel
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Benedict J Panizza
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mitesh Gandhi
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Queensland Xray, Brisbane, Queensland, Australia
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3
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Abdullaeva U, Pape B, Hirvonen J. Diagnostic Accuracy of MRI in Detecting the Perineural Spread of Head and Neck Tumors: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:113. [PMID: 38201423 PMCID: PMC10795679 DOI: 10.3390/diagnostics14010113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
The purpose of this study was to review the diagnostic accuracy of MRI in detecting perineural spreading (PNS) of head and neck tumors using histopathological or surgical evidence from the afflicted nerve as the reference standard. Previous studies in the English language published in the last 30 years were searched from PubMed and Embase databases. We included studies that used magnetic resonance imaging (MRI) (with and without contrast enhancement) to detect PNS, as well as the histological or surgical confirmation of PNS, and that reported the exact numbers of patients required for assessing diagnostic accuracy. The outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Heterogeneity was assessed with the Higgins inconsistency test (I2). P-values smaller than 0.05 were considered statistically significant. A total of 11 retrospective studies were found, reporting 319 nerve samples from 245 patients. Meta-analytic estimates and their 95% confidence intervals were as follows: sensitivity 0.85 (0.70-0.95), specificity 0.85 (0.80-0.89), PPV 0.86 (0.70-0.94), and NPV 0.85 (0.71-0.93). We found statistically significant heterogeneity for sensitivity (I2 = 72%, p = 0.003) and PPV (I2 = 70%, p = 0.038), but not for NPV (I2 = 65%, p = 0.119) or specificity (I2 = 12%, p = 0.842). The most frequent MRI features of PNS were nerve enlargement and enhancement. Squamous cell carcinoma and adenoid cystic carcinoma were the most common tumor types, and the facial and trigeminal nerves were the most commonly affected nerves in PNS. Only a few studies provided examples of false MRI diagnoses. MRI demonstrated high diagnostic accuracy in depicting PNS of cranial nerves, yet this statement was based on scarce and heterogeneous evidence.
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Affiliation(s)
- Umida Abdullaeva
- Department of Radiology, Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology, Tashkent 100054, Uzbekistan
| | - Bernd Pape
- Department of Biostatistics, University of Turku and Turku University Hospital, 20521 Turku, Finland;
- School of Technology and Innovations, University of Vaasa, 65101 Vaasa, Finland
| | - Jussi Hirvonen
- Department of Radiology, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, 33100 Tampere, Finland;
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention-Update 2023. Eur J Cancer 2023; 193:113251. [PMID: 37717283 DOI: 10.1016/j.ejca.2023.113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. Overall, cSCC mostly has very good prognosis after treatment, with 5-year cure rates greater than 90%. Despite the overall favourable prognosis and the proportionally rare deaths, cSCC is associated with a high total number of deaths due to its high incidence. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV) and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update recommendations on cSCC, based on current literature and expert consensus. Part 1 of the guidelines addresses the updates on classification, epidemiology, diagnosis, risk stratification, staging and prevention in immunocompetent as well as immunosuppressed patients.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital Zurich, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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Singh G, Tolkachjov SN, Farberg AS. Incorporation of the 40-Gene Expression Profile (40-GEP) Test to Improve Treatment Decisions in High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients: Case Series and Algorithm. Clin Cosmet Investig Dermatol 2023; 16:925-935. [PMID: 37051586 PMCID: PMC10083143 DOI: 10.2147/ccid.s403330] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
Cutaneous squamous cell carcinoma (cSCC) has become a significant public health issue due to its rapidly rising incidence and an estimated 1.8 million newly diagnosed cases annually. As with other cancers, treatment decisions for patients with cSCC are based primarily on a patient's risk for poor outcomes. There has been improvement in clinicopathologic factor-based risk assessment approaches, either through informal methods or ever evolving staging approaches. However, these approaches misidentify patients who will eventually have disease progression as low-risk and conversely, over classify patients as high-risk who do not experience relapse. To improve the accuracy of risk assessment for patients with cSCC, the 40-gene expression profile (40-GEP) test has been validated to show statistically significant stratification of a high-risk cSCC patient's risk of nodal or distant metastasis, independent of currently available risk-assessment methods. The 40-GEP test allows for a more accurate classification of metastatic risk for high-risk cSCC patients, with the aim to influence appropriate allocation of clinician time and therapeutic resources to those patients who will most benefit. The objective of this article is to present a treatment algorithm in which clinicians can easily integrate the results of the 40-GEP test into their current treatment approaches to tailor patient care based on individual tumor biology. The following modalities were considered: surveillance imaging, sentinel lymph node biopsy (SLNB), adjuvant radiation therapy (ART), and clinical follow-up. The authors have contributed their own cases for discussion as to how they have seen the beneficial impact of 40-GEP test results in their own practice. Overall, clinicians can identify risk-aligned treatment pathway improvements with the use of the 40-GEP test for challenging to manage, high-risk cSCC patients.
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Affiliation(s)
| | - Stanislav N Tolkachjov
- Epiphany Dermatology, Dallas, TX, USA
- University of Texas at Southwestern, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
- Texas A&M College of Medicine, Dallas, TX, USA
| | - Aaron S Farberg
- Texas A&M College of Medicine, Dallas, TX, USA
- Bare Dermatology, Dallas, TX, USA
- Baylor Scott & White Health System, Dallas, TX, USA
- Correspondence: Aaron S Farberg, Bare Dermatology, 2110 Research Row, Dallas, TX, 75235, USA, Tel +1 847-721-2725, Email
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6
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Hsieh KCJ, Addae-Mensah K, Alrohaibani Y, Goad A, Learned K. Perineural Spread of Tumor in the Skull Base and Head and Neck. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00006-7. [PMID: 37005170 DOI: 10.1016/j.coms.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Perineural tumor spread (PNS) is a well-recognized entity in head and neck cancers and represents a mode of metastasis along nerves. The trigeminal and facial nerves are most affected by PNS, and their connections are reviewed. MRI is the most sensitive modality for detecting PNS, and their anatomy and interconnections are reviewed. MRI is the most sensitive modality for detecting PNS, and imaging features of PNS and important imaging checkpoints are reviewed. Optimal imaging protocol and techniques are summarized as well as other entities that can mimic PNS.
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7
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Huang W, Li S, Luo C, Liang Z, Zhou S, Li H, Cai Y, Liang S, Ruan G, Cai P, Liu L. Prognostic value of MR-detected mandibular nerve involvement: potential indication for future individual induction chemotherapy in T4 nasopharyngeal carcinoma. J Cancer Res Clin Oncol 2023:10.1007/s00432-022-04533-w. [PMID: 36607430 PMCID: PMC10356880 DOI: 10.1007/s00432-022-04533-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To investigate the prognostic significance of MR-detected mandibular nerve involvement (MNI) and its value for induction chemotherapy (IC) administration in patients with nasopharyngeal carcinoma (NPC) and T4 disease. METHODS This retrospective study enrolled 792 non-metastatic, biopsy-proven NPC patients. Univariate and multivariate analysis were used to evaluate potential prognosticators. The inter-observer agreement was assessed by the kappa values. RESULTS MR-detected MNI was observed in 141 (72.3%) patients among 195 patients with T4 disease, with excellent agreement between the readers (kappa = 0.926). Patients with MR-detected MNI presented better 5-year overall survival (OS) (hazard ratio [HR], 0.40; P = 0.006) than those with MR-negative MNI. Of these patients, IC treatment was verified as an independent factor (HR: 0.35; P = 0.014) with preferable effect on OS. CONCLUSION MR-detected MNI could serve as an independent favorable prognostic predictor for OS in NPC patients with stage T4, which should be considered for stratifying these patients for IC administration.
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Affiliation(s)
- Wenjie Huang
- Departmentof Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Shuqi Li
- Departmentof Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Chao Luo
- Departmentof Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Zhiying Liang
- Departmentof Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Shumin Zhou
- Departmentof Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Haojiang Li
- Departmentof Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yi Cai
- Department of Radiology, Shengli Oilfield Central Hospital, No. 31 Jinan Road, Dongying District, Dongying, 257034, Shandong, People's Republic of China
| | - Shaobo Liang
- Department of Radiation Oncology, First People's Hospital of Foshan, Foshan, 528000, Guangdong, People's Republic of China.,Department of Radiation Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510000, Guangdong, People's Republic of China
| | - Guangying Ruan
- Departmentof Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Peiqiang Cai
- Departmentof Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Lizhi Liu
- Departmentof Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
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Rath TJ, Policeni B, Juliano AF, Agarwal M, Block AM, Burns J, Conley DB, Crowley RW, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Jain V, Powers WJ, Rosenow JM, Taheri MR, DuChene Thoma K, Zander D, Corey AS. ACR Appropriateness Criteria® Cranial Neuropathy: 2022 Update. J Am Coll Radiol 2022; 19:S266-S303. [PMID: 36436957 DOI: 10.1016/j.jacr.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Cranial neuropathy can result from pathology affecting the nerve fibers at any point and requires imaging of the entire course of the nerve from its nucleus to the end organ in order to identify a cause. MRI with and without intravenous contrast is often the modality of choice with CT playing a complementary role. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Tanya J Rath
- Division Chair of Neuroradiology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Bruno Policeni
- Panel Chair; Department of Radiology Vice-Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa; President Iowa Radiological Society and ACR Councilor
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; NI-RADS committee chair
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin; Fellowship Program Director
| | - Alec M Block
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Judah Burns
- Montefiore Medical Center, Bronx, New York; Vice-Chair for Education & Residency Program Director, Montefiore Medical Center; Vice-Chair, Subcommittee on Methodology
| | - David B Conley
- Practice Director, Northwestern ENT and Rhinology Fellowship Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Member, American Academy of Otolaryngology-Head and Neck Surgery
| | - R Webster Crowley
- Rush University Medical Center, Chicago, Illinois; Neurosurgery expert; Chief, Cerebrovascular and Endovascular Neurosurgery; Medical Director, Department of Neurosurgery; Surgical Director, Rush Comprehensive Stroke Center; Program Director, Endovascular Neurosurgery
| | | | - Elliott R Friedman
- University of Texas Health Science Center, Houston, Texas; Diagnostic Radiology Residency Program Director
| | - Maria K Gule-Monroe
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Medical Director of Diagnostic Imaging at Houston Area Location Woodlands
| | - Mari Hagiwara
- Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, New York University Langone Medical Center, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio; Medical Director, Lumina Imaging
| | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology
| | - Joshua M Rosenow
- Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia; Director of Neuroradiology
| | - Kate DuChene Thoma
- Director of Faculty Development Fellowship, University of Iowa Hospital, Iowa City, Iowa; Primary care physician
| | - David Zander
- Chief of Head and Neck Radiology, University of Colorado Denver, Denver, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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9
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Phung D, Ahmadi N, Gupta R, Clark JR, Wykes J, Ch'ng S, Elliott MS, Palme CE, Shannon K, Wu R, Lee JH, Low THH. Survival outcomes of perineural spread in head and neck cutaneous squamous cell carcinoma. ANZ J Surg 2022; 92:2299-2304. [PMID: 35866314 DOI: 10.1111/ans.17908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 06/06/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
AIM To present an institution's experience and survival outcomes for patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) and perineural spread (PNS). METHOD Retrospective study of patients with HNcSCC and PNS treated between January 2010 and August 2020 from the Sydney Head and Neck Cancer Institute database, Sydney, Australia; a high-volume, tertiary, academic head and neck centre. Patient demographics, primary site, involved cranial nerves, treatment modality, loco-regional failure and survival data were obtained. RESULTS Forty-five patients were identified, of which 32 patients were male (71%). Mean age at diagnosis was 68.7 years (range 43-90). Median follow-up was 16.1 months (range 1-107). The trigeminal nerve was most frequently involved (n = 30, 66.6%) followed by facial nerve (n = 13, 28.9%). Most patients underwent surgery followed by radiotherapy (n = 33, 73%) and eight received definitive radiotherapy. The median overall survival (OS) was 4.5 years (95% CI 3.71-5.38), median disease-specific survival 5.1 years (95% CI 4.21-5.97) and median disease-free survival (DFS) was 1.7 years (95% CI 1.11-2.22). The estimated 5-year OS and DFS were 45% and 25%, respectively. Patients treated with surgery and adjuvant radiotherapy with a clear proximal nerve margin had favourable DFS (P = 0.035) and trended towards better OS (P = 0.134) compared with patients with an involved nerve margin. Patients treated surgically with involved proximal nerve margins had similar outcomes compared with patients with treated definitive radiotherapy (HR 0.80, 95% CI 0.29-2.22, P = 0.664). CONCLUSION The likelihood of achieving a clear proximal nerve margin should be a strong consideration in the selection of appropriate patients for primary surgery.
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Affiliation(s)
- Daniel Phung
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Navid Ahmadi
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Wollongong Hospital, New South Wales, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kerwin Shannon
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Raymond Wu
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jenny H Lee
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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10
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Ahn GS, Hinds B, Kolb F, Reisenauer AK, Soon SL, Sepahdari AR, Bollin KB, Park SJ. Neurotropic Cutaneous Malignancies: Case Report on Keratinocyte Derived Malignancies of the Head and Neck With Perineural Invasion. Front Oncol 2022; 12:846278. [PMID: 35677168 PMCID: PMC9169718 DOI: 10.3389/fonc.2022.846278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background The recent addition of immunotherapy as a treatment modality to surgery and radiation has vastly improved disease control for patients with keratinocyte-derived carcinomas (KCs) that are incurable with local therapies alone. With the advent of immune checkpoint inhibitors (ICPis) in non-melanoma skin cancers comes diagnostic and therapeutic challenges when considering treatment strategies for patients presenting with clinical perineural invasion (cPNI) of locally advanced KC of the head and neck. Objectives We report four cases that convey the diagnostic and therapeutic complexity of managing patients with neuropathic symptoms from cutaneous neurotropic carcinomas of the head and neck. We also discuss an updated review regarding immunotherapies and perineural invasion within KC management. Conclusion Patients presenting with symptoms suspicious for cPNI warrant an expanded diagnostic evaluation to correlate neurological findings with neurotropic spread of disease. While nerve biopsies can be precarious in sensitive areas, a history of skin cancer and clinical presentation suggestive of neurotropism may be enough to pursue timely management in the form of surgery, radiation, and/or systemic therapy given each patient’s individual priorities, comorbidities, and prognosis. When adding ICPi as a treatment modality for patients with disease not amenable to local therapies, the potential for immune-related adverse events must be considered. A multi-disciplinary review and approach to the management of patients with KC and cPNI is essential for obtaining optimal patient outcomes.
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Affiliation(s)
- Grace Sora Ahn
- Department of Dermatology, University of California, San Diego, La Jolla, CA, United States
| | - Brian Hinds
- Department of Dermatology, University of California, San Diego, La Jolla, CA, United States
| | - Frederic Kolb
- Department of Plastic Surgery, University of California, San Diego, La Jolla, CA, United States
| | | | | | - Ali R Sepahdari
- Diagnostic Neuroradiology, Scripps Clinic Medical Group, La Jolla, CA, United States
| | - Kathryn B Bollin
- Division of Hematology and Oncology, Scripps MD Anderson Cancer Center, La Jolla, CA, United States
| | - Soo J Park
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
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11
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Schachtel MJC, Gandhi M, Bowman JJ, Porceddu SV, Panizza BJ. Facial nerve perineural spread from cutaneous squamous cell carcinoma of the head and neck: A single institution analysis of epidemiology, treatment, survival outcomes, and prognostic factors. Head Neck 2022; 44:1223-1236. [PMID: 35224794 PMCID: PMC9306800 DOI: 10.1002/hed.27017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/27/2022] [Accepted: 02/17/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study aimed to examine patients with facial nerve (VII) perineural spread (PNS) from cutaneous squamous cell carcinoma of the head and neck. METHODS Retrospective analysis of patients managed by an Australian tertiary center between 2000 and 2019. RESULTS Seventy three patients were included. Most presented with recurrent disease (89.0%) and simultaneous trigeminal nerve (V) involvement (67.1%). Of the 55 patients (75.3%) who received curative intent treatment, 48 received surgery plus/minus post-operative radiotherapy. In these patients, 5-year disease-free survival, disease-specific survival, and overall survival was 50.7%, 68.7%, and 58.1%, respectively. Pathological nodal disease, involved margins, increasing VII zonal extent, and concurrent zone 2 V PNS significantly worsened outcomes. CONCLUSION High rates of recurrent disease reflects the importance of adequate treatment of the primary. Surgery and post-operative radiotherapy remains the mainstay treatment. Outcomes are improved in early-stage disease and with clear surgical margins, reinforcing the need for prompt diagnosis and intervention.
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Affiliation(s)
- Michael J C Schachtel
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland.,Faculty of Medicine, University of Queensland, Brisbane, Queensland
| | - Mitesh Gandhi
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - James J Bowman
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland
| | - Sandro V Porceddu
- Faculty of Medicine, University of Queensland, Brisbane, Queensland.,Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Benedict J Panizza
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland.,Faculty of Medicine, University of Queensland, Brisbane, Queensland
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12
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Nightingale J, Gandhi M, Helena J, Bowman J, McGrath M, Coward J, Porceddu S, Ladwa R, Panizza B. Immunotherapy for the treatment of perineural spread in cutaneous head and neck squamous cell carcinoma: Time to rethink treatment paradigms. Head Neck 2022; 44:1099-1105. [PMID: 35156249 DOI: 10.1002/hed.27005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have shown promising antitumour activity. Application in head and neck cutaneous squamous cell carcinoma (cSCC) large nerve perineural spread (PNS) is limited. METHODS Retrospective review of 13 patients with PNS receiving anti-PD-1 therapy from September 2017 to May 2021 is presented. Primary endpoints were objective response (complete or partial response) and median time to progression, determined by Head and Neck Multi-Disciplinary Team (MDT) and independent radiology review of magnetic resonance imaging (MRI) and/or computed tomography/positron emission tomography (CT/PET). RESULTS Objective response was observed in 9/13 patients (69%), with complete response in 6 (46%) and partial response in 3 patients (23%). Median time to response was 2.1 months (IQR 1.8-2.7 months). There were 3 (23%) patients with progressive disease, with median time to progression of 3.5 months. There were no grade 3-4 treatment related adverse events. CONCLUSIONS This case series supports developing evidence for anti-PD-1 checkpoint inhibitor therapy for perineural spread, supporting future prospective clinical trials in this patient population.
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Affiliation(s)
- James Nightingale
- Department of Otolaryngology - Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mitesh Gandhi
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jonathan Helena
- Department of Otolaryngology - Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - James Bowman
- Department of Otolaryngology - Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Margaret McGrath
- Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jermaine Coward
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,ICON Cancer Centre, Level 5, Mater Medical Centre, Brisbane, Queensland, Australia
| | - Sandro Porceddu
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Rahul Ladwa
- Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Benedict Panizza
- Department of Otolaryngology - Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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13
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Radiation Therapy for Adenoid Cystic Carcinoma of the Head and Neck. Cancers (Basel) 2021; 13:cancers13246335. [PMID: 34944955 PMCID: PMC8699151 DOI: 10.3390/cancers13246335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Adenoid cystic carcinoma is a rare histology arising in the head and neck region that has a high propensity for perineural invasion. While surgical resection is the preferred primary treatment modality, adjuvant radiotherapy is often indicated to improve local control. For unresectable disease, definitive radiotherapy can be utilized. Given the predilection for perineural tumor spread, target volumes often must encompass relevant nerve pathways back to the base of skull. Treatment strategies for ACC must therefore balance the disease burden and risk of failure against the morbidity of treatment. Abstract Adenoid cystic carcinoma of the head and neck is an uncommon malignancy that can arise in the major or minor salivary glands. Perineural invasion (PNI) is an extremely frequent finding in cases of adenoid cystic carcinoma (ACC) that can be associated with significant patient morbidity and poor prognosis. By contrast, ACC rarely demonstrates lymphovascular space invasion thereby making PNI the major avenue for metastasis and a driver of treatment rationale and design. Radiotherapy is often utilized post-operatively to improve locoregional control or as a primary therapy in unresectable disease. Here we aim to review the role of radiotherapy in the management of this malignancy with a focus on target delineation and treatment regimens in the definitive, recurrent, and metastatic settings.
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14
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Abstract
Perineural extension is an increasingly recognized pathway of extension of cutaneous, mucosal, and salivary gland neoplasms associated with a severe adverse prognosis. Imaging identification is feasible by MR imaging 3-dimensional contrast-enhanced submillimetric sequences. The trigeminal nerve branches and facial nerve are the most commonly involved. PET with computed tomography may aid in the identification of the primary tumor location or recognition of recurrence, but only in conjunction with MR imaging does it achieve similar detection rates for perineural extension. Computed tomography scanning is an adjunct to MR imaging to increase specificity and for surgical treatment planning.
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15
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New and Advanced Magnetic Resonance Imaging Diagnostic Imaging Techniques in the Evaluation of Cranial Nerves and the Skull Base. Neuroimaging Clin N Am 2021; 31:665-684. [PMID: 34689938 DOI: 10.1016/j.nic.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The skull base and cranial nerves are technically challenging to evaluate using magnetic resonance (MR) imaging, owing to a combination of anatomic complexity and artifacts. However, improvements in hardware, software and sequence development seek to address these challenges. This section will discuss cranial nerve imaging, with particular attention to the techniques, applications and limitations of MR neurography, diffusion tensor imaging and tractography. Advanced MR imaging techniques for skull base pathology will also be discussed, including diffusion-weighted imaging, perfusion and permeability imaging, with a particular focus on practical applications.
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16
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Leedman S, Wormald R, Flukes S. Lateral temporal bone resection for cutaneous carcinomas of the external auditory canal and peri-auricular region. J Laryngol Otol 2021; 135:1-6. [PMID: 34583793 DOI: 10.1017/s0022215121002607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure. METHODS A retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia. RESULTS Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30). CONCLUSION Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup.
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Affiliation(s)
- S Leedman
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
| | - R Wormald
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
| | - S Flukes
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
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17
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Hazim AZ, Reed CT, Price KA, Foote RL, Ma DJ, Neben-Wittich M, DeLone DR, Jenkins SM, Smith CY, Chintakuntlawar AV. Survival outcomes in locally advanced cutaneous squamous cell carcinoma presenting with clinical perineural invasion alone. Head Neck 2021; 43:1995-2001. [PMID: 33644935 DOI: 10.1002/hed.26661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/11/2021] [Accepted: 02/19/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cutaneous squamous cell carcinomas (CSCC) involving the head and neck are common, but initial presentation or recurrence limited to the cranial nerves is rare. METHODS We conducted a retrospective study of 21 patients with clinical perineural invasion (PNI) from CSCC and no measurable disease by RECIST 1.1. Patients treated with radiotherapy or chemoradiotherapy were included. RESULTS The median time from symptom onset until diagnosis was 13.0 months (2.6-83.1). All patients received radiotherapy. Fourteen received concurrent systemic therapy. The median follow-up time was 30.5 months (1.1-106.0). Ten patients recurred, with the majority being locoregional. The 2-year overall survival rate was 85%. The median progression-free survival (PFS) was 21.5 months with an estimated 2-year PFS of 44.5% (95%CI: 22.3-66.8). CONCLUSIONS CSCCs with clinical PNI alone are difficult to diagnose and can have a long interval between appearance of symptoms and diagnosis. They can successfully be treated with chemoradiotherapy. However, many patients still suffer from locoregional recurrences.
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Affiliation(s)
- Antonious Z Hazim
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Clay T Reed
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David R DeLone
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
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18
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Dür C, Salmina C, Borner U, Giger R, Nisa L. Relevance of Intraparotid Metastases in Head and Neck Skin Squamous Cell Carcinoma. Laryngoscope 2020; 131:788-793. [PMID: 32918494 DOI: 10.1002/lary.28985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Parotid lymph node metastases are common in head and neck cutaneous squamous cell carcinoma (cSCCHN). Here we evaluate the diagnostic, prognostic, and therapeutic implications of intraglandular lymph node (IGLN) metastases in cSCCHN. STUDY DESIGN Retrospective study in a tertiary referral university cancer institute. METHODS We included patients with cSCCHN who underwent parotidectomy and neck dissection (ND), with or without synchronous resection of the skin primary, between January 1999 and January 2018. The characteristics of cSCCHN with or without IGLN involvement were compared. RESULTS Altogether, 68 patients were included. Of the 29 (42.6%) patients classified as cN0, eight were upstaged pN+ and had concomitant IGLN involvement. Of 21 patients with pN0 disease, IGLN metastases were absent in only three cases, resulting in a specificity and sensitivity of parotid metastases to diagnose occult nodal neck metastases of 14.29% and 100%, respectively. The positive and negative predictive values were 14.29% and 100%, respectively. Univariate analyses only displayed a significantly higher rate of moderately and poorly differentiated primaries in patients with IGLN metastases (P = .015). Only advanced T-stages were significantly associated with neck recurrences. CONCLUSION IGLN status in advanced cSCCHN is potentially predictive for occul nodal neck metastases. Our results suggest that ND in patients with histopathologically negative IGLNs and clinically negative neck lymph nodes may not be necessary given the high negative predictive value of IGLN status in this group of patients. Therefore, accurate diagnostic evaluation of IGLN involvement is mandatory. LEVEL OF EVIDENCE 4 Laryngoscope, 131:788-793, 2021.
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Affiliation(s)
- Cilgia Dür
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Cinzia Salmina
- Department of Otorhinolaryngology, Head and Neck Surgery; Hospitals FMI AG, Unterseen, Switzerland
| | - Urs Borner
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lluís Nisa
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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19
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Patterson JD, Helton M, Khani M, Sardar S, Thomas K, Galhardo EP, Penagaricano JA, Day JD, Rodriguez A. Neurosurgical management of perineural metastases: A case series and review of the literature. Surg Neurol Int 2020; 11:206. [PMID: 32874709 PMCID: PMC7451152 DOI: 10.25259/sni_146_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Perineural invasion (PNI) and spread are one of the grimmest prognostic factors associated with primary skin and head-and-neck cancers, yet remain an often confused, and underreported, phenomenon. Adding complexity to reaching a diagnosis and treating perineural spread (PNS) is the finding that patients may have no known primary tumor, history of skin cancer, and/or incidental PNI in the primary tumor. These delays in diagnosis and treatment are further compounded by an already slow disease process and often require multidisciplinary care with combinations of stereotactic radiosurgery, surgical resection, and novel treatments such as checkpoint inhibitors. Methods: Six patients with metastatic cancer to the cranial nerves who underwent Gamma Knife radiosurgery (GKRS) treatment were chosen for retrospective analysis. This information included age, gender, any past surgeries (both stereotactic and regular surgery), dose of radiation and volume of the tumor treated in the GKRS, date of PNS, comorbidities, the patient follow-up, and pre- and post-GKRS imaging. The goal of the follow-up with radiographing imaging was to assess the efficacy of GKSS. Results: The clinical course of six patients with PNS is presented. Patients followed variable courses with mixed outcomes: two patients remain living, one was lost to follow-up, and three expired with a median survival of 12 months from date of diagnosis. Patients at our institution are ideally followed for life. Conclusion: Given the morbidity and mortality of PNS of cancer, time is limited, and further understanding is required to improve outcomes. Here, we provide a case series of patients with PNS treated with stereotactic radiosurgery, discuss their clinical courses, and review the known literature.
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Affiliation(s)
- John D Patterson
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Matthew Helton
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mehdi Khani
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sehrish Sardar
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kevin Thomas
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Edvaldo P Galhardo
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jose A Penagaricano
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States
| | - John D Day
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Analiz Rodriguez
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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20
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Schroeder C, Lee JH, Tetzner U, Seidel S, Kim SY. Comparison of diffusion-weighted MR imaging and 18F Fluorodeoxyglucose PET/CT in detection of residual or recurrent tumors and delineation of their local spread after (chemo) radiotherapy for head and neck squamous cell carcinoma. Eur J Radiol 2020; 130:109157. [PMID: 32652403 DOI: 10.1016/j.ejrad.2020.109157] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) and fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detection of residual or recurrent tumors and their local extension in patients with head and neck squamous cell carcinoma after treatment with (chemo) radiotherapy (CRT). METHOD Twenty-five patients (17 men, 8 women, median age 64 years, range 49-79) who underwent surgical salvage for residual or recurrent tumors after CRT were included. The histopathologic analysis after the surgical salvage served as the gold standard. RESULTS Both DW-MRI and 18F-FDG PET/CT had a sensitivity of 92 % (23/25) in the detection of residual or recurrent tumors. MRI had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting perineural spread of 62 % (5/8), 88 % (15/17), 71 % (5/7) and 83 % (15/18), respectively; in comparison, PET/CT did not detect any cases of perineural spread. The sensitivity, specificity, PPV and NPV of MRI in detecting muscle infiltration was 75 % (9/12), 77 % (10/13), 75 % (9/12) and 77 % (10/13) respectively, while the values for 18F-FDG PET/CT were 58 % (7/12), 69 % (9/13), 64 % (7/11) and 64 % (9/14). CONCLUSIONS DW-MRI- and 18F-FDG PET/CT-imaging have an identical detection rate of residual or recurrent tumors after (chemo) radiotherapy. MRI has a higher sensitivity in detecting local perineural spread, has a better accuracy in the detection of muscle infiltration and more accurately correlates the lesion size to the histopathologic specimen.
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Affiliation(s)
- Christophe Schroeder
- University Institute for Diagnostic, Interventional and Paediatric Radiology, Inselspital University Hospital Bern, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
| | - Jung-Hyun Lee
- Department of Microbiology, The University of Chicago, Chicago, IL 60637, USA
| | - Ulrich Tetzner
- BG Klinikum Halle, Institute for Radiology and Neuroradiology, Merseburger Strasse 165, 06112 Halle (Saale), Germany
| | - Stefan Seidel
- Spitäler Schaffhausen, Radiology and Nuclear Medicine, Geissbergstrasse 81, 8208 Schaffhausen, Switzerland
| | - Soung Yung Kim
- Spitäler Schaffhausen, Radiology and Nuclear Medicine, Geissbergstrasse 81, 8208 Schaffhausen, Switzerland
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21
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European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention. Eur J Cancer 2020; 128:60-82. [PMID: 32113941 DOI: 10.1016/j.ejca.2020.01.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in the white populations, accounting for 20% of all cutaneous malignancies. Factors implicated in cSCC etiopathogenesis include ultraviolet radiation exposure and chronic photoaging, age, male sex, immunosuppression, smoking and genetic factors. A collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organisation of Research and Treatment of Cancer (EORTC) was formed to update recommendations on cSCC classification, diagnosis, risk stratification, staging and prevention, based on current literature, staging systems and expert consensus. Common cSCCs are typically indolent tumors, and most have a good prognosis with 5-year cure rates of greater than 90%, and a low rate of metastases (<4%). Further risk stratification into low-risk or high-risk common primary cSCC is recommended based on proposed high-risk factors. Advanced cSCC is classified as locally advanced (lacSCC), and metastatic (mcSCC) including locoregional metastatic or distant metastatic cSCC. Current systems used for staging include the American Joint Committee on Cancer (AJCC) 8th edition, the Union for International Cancer Control (UICC) 8th edition, and Brigham and Women's Hospital (BWH) system. Physical examination for all cSCCs should include total body skin examination and clinical palpation of lymph nodes, especially of the draining basins. Radiologic imaging such as ultrasound of the regional lymph nodes, magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography-computed tomography (PET-CT) scans are recommended for staging of high-risk cSCC. Sentinel lymph node biopsy is currently not recommended. Nicotinamide, oral retinoids, and topical 5-FU have been used for the chemoprevention of subsequent cSCCs in high-risk patients but are not routinely recommended. Education about sun protection measures including reducing sun exposure, use of protective clothing, regular use of sunscreens and avoidance of artificial tanning, is recommended.
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22
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Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is the second most common skin malignancy. Computed tomography (CT) and/or MRI are commonly used for staging, however, the role of fluorine-18-fluorodeoxyglucose (F-FDG)-PET is not clearly established. In this study, we evaluated F-FDG-PET/CT imaging for initial staging of cSCC. PATIENTS AND METHODS F-FDG-PET/CT scans performed in patients with newly diagnosed cSCC were reviewed retrospectively. Images were visually assessed for lesions and F-FDG uptake [standardized uptake value (SUV)] in primary and secondary sites was measured. Suspected lesions on F-FDG-PET/CT were correlated with histopathology when available, follow-up imaging or clinical data in others. RESULTS Twenty-three cSCC patients who underwent F-FDG-PET/CT at diagnosis were evaluated. Primary sites were in head/neck (n=21), chest (n=1), and foot (n=1). All patients had F-FDG-positive scans with a total of 51 F-FDG-positive lesions. All primary lesions (n=24) were F-FDG-positive (SUV: 2.3-22.8; mean 10.2), and additional 27 F-FDG-positive lesions, including 21 nodes, four cutaneous, one osseous and one lung lesion, were noted in 13 patients. Mean size of F-FDG-positive nodes was 0.9 cm (range: 0.4-2.5 cm), predominantly clinically impalpable. Pathology was available for 40/51 lesions; 31 sites positive for malignancy. SUV (mean±SD) was 9.2±6.2 for malignant and 2.7±1.2 for benign lesions. Sensitivity, positive predictive value, and accuracy of F-FDG-PET/CT scan were 100, 77.5, and 77.5%, respectively. F-FDG detected seven additional lesions in three patients, compared to CT/MRI. Overall, staging F-FDG-PET/CT detected nine prior unknown lesions in five patients that were proven metastatic disease by histopathology or follow-up; F-FDG-PET/CT modified management in 5/23 (21.7%) patients. CONCLUSION F-FDG-PET/CT has high sensitivity in the detection of cSCC lesions, including small cutaneous and nodal disease, and has a potential role in initial staging and management.
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Dulguerov P, Broglie MA, Henke G, Siano M, Putora PM, Simon C, Zwahlen D, Huber GF, Ballerini G, Beffa L, Giger R, Rothschild S, Negri SV, Elicin O. A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study-Part 1 (Head and Neck Surgery). Front Oncol 2019; 9:1125. [PMID: 31709185 PMCID: PMC6822016 DOI: 10.3389/fonc.2019.01125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The Head and Neck Cancer Working Group of Swiss Group for Clinical Cancer Research (SAKK) has investigated the level of consensus (LOC) and discrepancy in everyday practice of diagnosis and treatment in head and neck cancer. Materials and Methods: An online survey was iteratively generated with 10 Swiss university and teaching hospitals. LOC below 50% was defined as no agreement, while higher LOC were arbitrarily categorized as low (51-74%), moderate (75-84%), and high (≥85%). Results: Any LOC was achieved in 62% of topics (n = 60). High, moderate and low LOC were found in 18, 20, and 23%, respectively. Regarding Head and Neck Surgery, Radiation Oncology, Medical Oncology, and biomarkers, LOC was achieved in 50, 57, 83, and 43%, respectively. Conclusions: Consensus on clinical topics is rather low for surgeons and radiation oncologists. The questions discussed might highlight discrepancies, stimulate standardization of practice, and prioritize topics for future clinical research.
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Affiliation(s)
- Pavel Dulguerov
- Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Guido Henke
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marco Siano
- Department of Medical Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Medical Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Simon
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
- Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Giorgio Ballerini
- Department of Radiation Oncology, Clinica Luganese SA, Lugano, Switzerland
| | - Lorenza Beffa
- Department of Radiation Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sacha Rothschild
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - Sandro V. Negri
- Department of Otorhinolaryngology, Lindenhofspital, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Mahajan S, Barker CA, Mauguen A, Singh B, Pandit-Taskar N. Restaging [ 18F] fludeoxyglucose positron emission tomography/computed tomography scan in recurrent cutaneous squamous cell carcinoma: Diagnostic performance and prognostic significance. J Am Acad Dermatol 2019; 82:878-886. [PMID: 31562942 DOI: 10.1016/j.jaad.2019.09.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/09/2019] [Accepted: 09/17/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are no specific recommendations for [18F] fludeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in assessing recurrent cutaneous squamous cell carcinoma (cSCC). OBJECTIVE To evaluate FDG-PET/CT in recurrent cSCC. METHODS FDG-PET/CT scans were retrospectively reviewed. Sites of abnormal uptake were noted and correlated with biopsy/histopathology studies, where available, and with follow-up imaging or clinical data in others. Comparison with available CT/magnetic resonance imaging was performed. The prognostic significance of PET/CT parameters was evaluated, and PET/CT-based change in management was recorded. RESULTS A total of 115 FDG-PET/CT scans were analyzed in 100 consecutive patients with cSCC. Of these, 96 (84%) scans were positive for recurrence, and 25 showed distant metastases. PET/CT detected unsuspected disease sites in 39 of 115 scans (34%), locoregional disease in 14, distant metastases in 11, both locoregional disease and distant metastases in 8, additional local cutaneous disease in 5, and second malignancy in 1. Comparison of 78 PET/CT scans with available CT/magnetic resonance imaging showed 37 additional abnormalities on 23 PET/CT scans, predominantly including skin/subcutaneous lesions and nodes. PET/CT led to change in management in 28% of patients. On univariate/multivariate analysis, increased number of FDG-positive lesions and lung metastases on PET/CT was associated with increased risk of death/disease progression. LIMITATIONS Retrospective study. CONCLUSIONS FDG-PET/CT was sensitive in detecting recurrent disease in cSCC, led to change in management for 28% of patients, and proved to be of prognostic value.
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Affiliation(s)
- Sonia Mahajan
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bhuvanesh Singh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neeta Pandit-Taskar
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Nader ME, Ginsberg LE, Bell D, Roberts DB, Gidley PW. Evaluating Perineural Spread to the Intratemporal Facial Nerve on Magnetic Resonance Imaging. Otolaryngol Head Neck Surg 2019; 160:1087-1094. [DOI: 10.1177/0194599819827848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To determine the sensitivity and specificity of magnetic resonance imaging (MRI) for the detection of perineural spread (PNS) along the intratemporal facial nerve (ITFN) in patients with head and neck cancers. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods We included 58 patients with head and neck malignancies who underwent sacrifice of the ITFN between August 1, 2002, and November 30, 2015. Demographics, preoperative facial nerve function, prior oncologic treatment, and timing between MRI and surgery were recorded. Histopathology slides and preoperative MRI were reviewed retrospectively by a neuropathologist and a neuroradiologist, respectively, both blinded to clinical data. The mastoid segment of the facial nerve (referred to as the descending facial nerve [DFN]) and stylomastoid foramen (SMF) were evaluated separately. A grading system was devised when radiographically assessing PNS along the DFN. Results Histopathologic evidence of PNS was found in 21 patients (36.2%). The sensitivity and specificity of MRI in detecting PNS to the DFN were 72.7% and 87.8%, respectively. MRI showed higher sensitivity but slightly lower specificity when evaluating the SMF (80% and 82.8%, respectively). Prior oncologic treatment did not affect the false-positive rate ( P = .7084). Sensitivity was 100% when MRI was performed within 2 weeks of surgery and was 62.5% to 73.3% when the interval was greater than 2 weeks. This finding was not statistically significant (SMF, P = .7076; DFN, P = .4143). Conclusion MRI shows fair to good sensitivity and good specificity when evaluating PNS to the ITFN.
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Affiliation(s)
- Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lawrence E. Ginsberg
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dianna B. Roberts
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul W. Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Practical clinical guidelines for contouring the trigeminal nerve (V) and its branches in head and neck cancers. Radiother Oncol 2018; 131:192-201. [PMID: 30206021 DOI: 10.1016/j.radonc.2018.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE The trigeminal nerve (V) is a major route of tumor spread in several head and neck cancers. However, only limited data are currently available for its precise contouring, although this is absolutely necessary in the era of intensity-modulated radiation therapy (IMRT). The purpose of this article is to present practical clinical guidelines for contouring the trigeminal nerve (V) in head and neck cancers at risk of spread along this nerve. METHOD The main types of head and neck cancers associated with risks of spread along the trigeminal nerve (V) and its branches were comprehensively reviewed based on clinical experience, literature-based patterns of failure, anatomy and radio-anatomy. A consensus for contouring was proposed based on a multidisciplinary approach among head and neck oncology experts including radiation oncologists (JBi, ML, MO, VG and JB), a radiologist (VD) and a surgeon (CS). These practical clinical guidelines have been endorsed by the GORTEC (Head and Neck Radiation Oncology Group). RESULTS We provided contouring and treatment guidelines, supported by detailed figures and tables to help, for the trigeminal nerve and its branches: the ophthalmic nerve (V1), the maxillary nerve (V2) and the manidibular nerve (V3). A CT- and MRI-based atlas was proposed to illustrate the whole trigeminal nerve pathway with its main branches. CONCLUSION Trigeminal nerve (V) invasion is an important component of the natural history of various head and neck cancers. Recognizing the radio-anatomy and potential routes of invasion is essential for optimal contouring, as presented in these guidelines.
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Kirsch CF, Schmalfuss IM. Practical Tips for MR Imaging of Perineural Tumor Spread. Magn Reson Imaging Clin N Am 2018; 26:85-100. [DOI: 10.1016/j.mric.2017.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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Linedale R, Schmidt C, King BT, Ganko AG, Simpson F, Panizza BJ, Leggatt GR. Elevated frequencies of CD8 T cells expressing PD-1, CTLA-4 and Tim-3 within tumour from perineural squamous cell carcinoma patients. PLoS One 2017; 12:e0175755. [PMID: 28423034 PMCID: PMC5396892 DOI: 10.1371/journal.pone.0175755] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/30/2017] [Indexed: 12/31/2022] Open
Abstract
Perineural spread of tumour cells along cranial nerves is a severe complication of primary cutaneous squamous cell carcinomas of the head and neck region. While surgical excision of the tumour is the treatment of choice, removal of all the tumour is often complicated by the neural location and recurrence is frequent. Non-invasive immune treatments such as checkpoint inhibitor blockade may be useful in this set of tumours although little is understood about the immune response to perineural spread of squamous cell carcinomas. Immunohistochemistry studies suggest that perineural tumour contains a lymphocyte infiltrate but it is difficult to quantitate the different proportions of immune cell subsets and expression of checkpoint molecules such as PD-1, Tim-3 and CTLA-4. Using flow cytometry of excised perineural tumour tissue, we show that a T cell infiltrate is prominent in addition to less frequent B cell, NK cell and NKT cell infiltrates. CD8 T cells are more frequent than other T cells in the tumour tissue. Amongst CD8 T cells, the frequency of Tim-3, CTLA-4 and PD-1 expressing cells was significantly greater in the tumour relative to the blood, a pattern that was repeated for Tim-3, CTLA-4 and PD-1 amongst non-CD8 T cells. Using immunohistochemistry, PD-1 and PD-L1-expression could be detected in close proximity amongst perineural tumour tissue. The data suggest that perineural SCC contains a mixture of immune cells with a predominant T cell infiltrate containing CD8 T cells. Elevated frequencies of tumour-associated Tim-3+, CTLA-4+ and PD-1+ CD8 T cells suggests that a subset of patients may benefit from local antibody blockade of these checkpoint inhibitors.
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Affiliation(s)
- Richard Linedale
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Campbell Schmidt
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia.,Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland Faculty of Medicine, Brisbane, Australia
| | - Brigid T King
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia.,The University of Queensland Faculty of Medicine, Brisbane, Australia
| | - Annabelle G Ganko
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia.,The University of Queensland Faculty of Medicine, Brisbane, Australia
| | - Fiona Simpson
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Benedict J Panizza
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Australia.,The University of Queensland Faculty of Medicine, Brisbane, Australia
| | - Graham R Leggatt
- The University of Queensland Diamantina Institute, The University of Queensland, Translational Research Institute, Brisbane, Australia
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The role of perineural invasion in treatment decisions for oral cancer patients: A review of the literature. J Craniomaxillofac Surg 2017; 45:821-825. [PMID: 28359633 DOI: 10.1016/j.jcms.2017.02.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/29/2017] [Accepted: 02/17/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The role of perineural invasion (PNI) in the management of patients with oral squamous cell carcinoma (OSSC) is still controversial, and there is no consensus regarding the most appropriate therapeutic approach. The purpose of this study is to review the findings in the literature describing OSCC as a neurotropic malignancy, with the aim of correlating perineural invasion with treatment decisions and disease prognosis. MATERIALS AND METHODS A literature search was conducted of references based on the MEDLINE and Cochrane Database of Systematic Reviews, with subject keywords including four main categories: perineural invasion, perineural spread, oral squamous cell cancinoma, neurotropic carcinoma. RESULTS In this systematic review and analysis, more than 350 publications met the eligibility criteria of the authors. CONCLUSION Perineural invasion (PNI) is a widely recognized indicator of poor prognosis in oral cancer patients, strongly correlating with aggressive tumor behavior, disease recurrence, and increased morbidity and mortality. Elective neck dissection could be an indicator in improving neck control in PNI-positive patients, while the addition of adjuvant postoperative radiotherapy may not significantly improve survival rates. Various molecular markers have been correlated with perineural tumor spread, but further investigations are required before targeting PNI as part of advanced cancer therapies.
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30
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Imaging of palatal lumps. Clin Radiol 2017; 72:97-107. [DOI: 10.1016/j.crad.2016.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 12/30/2022]
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31
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Li T, Sheng L, Chunyan C, Haoqiang H, Kangqiang P, Xiao G, Lizhi L. The significance of diffusion tensor magnetic resonance imaging for patients with nasopharyngeal carcinoma and trigeminal nerve invasion. Medicine (Baltimore) 2017; 96:e6072. [PMID: 28178163 PMCID: PMC5313020 DOI: 10.1097/md.0000000000006072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/22/2016] [Accepted: 01/16/2017] [Indexed: 11/25/2022] Open
Abstract
To investigate the significance of diffusion tensor imaging (DTI) for patients with nasopharyngeal carcinoma (NPC) and trigeminal nerve invasion.Fifty-two patients with NPC and unilateral infringement and 30 healthy controls were recruited for our study. Routine magnetic resonance imaging (MRI) and DTI were performed for all participants. Within-group and between-group comparisons of DTI metrics, including fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) of the third (V3) branch of the bilateral trigeminal nerves of all participants, were carried out.The FA and ADC values on the affected sides of patients revealed a significant decrease and increase, respectively, when compared with those on the unaffected sides of patients and the healthy controls (P = 0.000 for all), whereas there were no significant differences in DTI metrics between both sides of healthy controls or between the unaffected sides of patients and the healthy controls (P = 0.930, 0.580, 0.095, and 0.360, respectively). The decreasing FA rate on the affected sides of patients correlated negatively with the increasing ADC rate (r = -0.675, P = 0.000).DTI can quantitatively evaluate microstructural abnormalities of the V3 branch of the trigeminal nerve in patients with NPC, which is important for the early detection of trigeminal nerve invasion to achieve a precise T classification, assess prognosis, and guide treatment.
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Affiliation(s)
- Tian Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Li Sheng
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Cui Chunyan
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - He Haoqiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Peng Kangqiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Gong Xiao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Liu Lizhi
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
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Bourque PR, Bourque G, Miller W, Woulfe J, Warman Chardon J. Combined isolated trigeminal and facial neuropathies from perineural invasion by squamous cell carcinoma: A case series and review of the literature. J Clin Neurosci 2017; 35:5-12. [DOI: 10.1016/j.jocn.2016.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/26/2016] [Indexed: 02/01/2023]
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Palejwala SK, Barry JY, Rodriguez CN, Parikh CA, Goldstein SA, Lemole GM. Combined approaches to the skull base for intracranial extension of tumors via perineural spread can improve patient outcomes. Clin Neurol Neurosurg 2016; 150:46-53. [DOI: 10.1016/j.clineuro.2016.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/23/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022]
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Role of targeted magnetic resonance imaging sequences in the surgical management of anterior skull base pathology. The Journal of Laryngology & Otology 2016; 131:S57-S61. [PMID: 27762178 DOI: 10.1017/s0022215116008240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The skull base is a highly complex anatomical region that provides passage for important nerves and vessels as they course into and out of the cranial cavity. Key to the management of pathology in this region is a thorough understanding of the anatomy, with its variations, and the relationship of various neurovascular structures to the pathology in question. Targeted high-resolution magnetic resonance imaging on high field strength magnets can enable the skull base surgeon to understand this intricate relationship and deal with the pathology from a position of relative advantage. OBJECTIVE With the help of case studies, this paper illustrates the application of specialised magnetic resonance techniques to study pathology of the orbital apex in particular. CONCLUSION The fine anatomical detail provided gives surgeons the ability to design an endonasal endoscopic procedure appropriate to the anatomy of the pathology.
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Keerthi R, Dutta A, Agarwal S, Kani V, Khatua A. Perineural Invasion of Oral Squamous Cell Carcinoma: A New Hurdle for Surgeons. J Maxillofac Oral Surg 2016; 17:59-63. [PMID: 29382995 DOI: 10.1007/s12663-016-0943-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/12/2016] [Indexed: 01/28/2023] Open
Abstract
The high rate of mortality associated with cancer is due to its inherent nature to metastasize. Perineural invasion (PNI) is a relatively rare mode of metastasis, and a distinct pathologic entity that can be observed in the absence of lymphatic or vascular invasion which is still shrouded by mystery. PNI is a marker of poor prognosis. Despite increasing recognition of this metastatic process, there has been little progress in the understanding of mechanisms behind PNI. The purpose of this article is to make surgeons aware of caudad to cephalad metastasis of oral cancer along trigeminal nerve.
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Affiliation(s)
- R Keerthi
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, Bangalore, India
| | - Abhishek Dutta
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, Bangalore, India
| | - Shruthi Agarwal
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, Bangalore, India
| | - Vikram Kani
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, Bangalore, India
| | - Abhishek Khatua
- Department of Oral and Maxillofacial Surgery, V.S. Dental College and Hospital, Bangalore, India
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Skin cancer of the head and neck with gross or microscopic perineural involvement: Patterns of failure. Radiother Oncol 2016; 120:81-6. [DOI: 10.1016/j.radonc.2016.06.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 06/10/2016] [Accepted: 06/14/2016] [Indexed: 11/24/2022]
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Gorayski P, Foote M, Porceddu S, Poulsen M. The Role of Postoperative Radiotherapy for Large Nerve Perineural Spread of Cancer of the Head and Neck. J Neurol Surg B Skull Base 2016; 77:173-81. [PMID: 27123394 DOI: 10.1055/s-0036-1571839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Large nerve perineural spread (LNPNS) is an uncommon but serious sequelae of cutaneous and salivary gland malignancies arising in the head and neck. This distinct clinical entity is caused by malignant cell spread along the course of larger (named) cranial nerves in a bidirectional pattern of spread toward the origins of the nerve in the brainstem and/or its most distal branches residing in the dermis. Untreated, LNPNS causes multiple cranial neuropathies that significantly impact on quality of life and ultimately is fatal. Curative treatment involves en bloc surgical resection of all known involved sites of gross disease followed by risk-adapted postoperative radiotherapy (PORT) to improve local control. We review the evidence for contemporary practice and outline the processes involved in the delivery of PORT using the zonal anatomical classification.
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Affiliation(s)
- Peter Gorayski
- Radiation Oncology Centres, Mater Private Hospital Springfield, Springfield, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Matthew Foote
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sandro Porceddu
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Michael Poulsen
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Radiation Oncology Mater Centre, Brisbane, Queensland, Australia
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Warren TA, Whiteman DC, Porceddu SV, Panizza BJ. Insight into the epidemiology of cutaneous squamous cell carcinoma with perineural spread. Head Neck 2016; 38:1416-20. [PMID: 27043827 DOI: 10.1002/hed.24453] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/09/2016] [Accepted: 02/08/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Perineural spread (PNS) of cutaneous squamous cell carcinoma of the head and neck (SCCHN) can be associated with poor outcomes. Disease understanding and awareness is limited leading to delayed diagnosis and treatment. The purpose of this study was to identify epidemiological features of patients with PNS of cutaneous SCCHN. METHODS Tumor characteristics and demographics of patients with PNS of cutaneous SCCHN managed through a single institution were collected between 1998 and 2013. RESULTS One hundred twenty patients were included in this study. The majority had a history of skin cancer (85.8%). The median time from primary tumor treatment to PNS symptom onset was 16 months (range, 1-86 months). A total of 34.2% had no perineural invasion (PNI) detected in the primary, and 22.5% had no known primary tumor. Only 5.8% of the patients had nodal involvement at presentation. CONCLUSION Patients can present with PNS from cutaneous SCCHN with no known primary tumor or with primary tumors without PNI. The majority of patients presented without regional nodal involvement. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1416-1420, 2016.
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Affiliation(s)
- Timothy A Warren
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Sandro V Porceddu
- School of Medicine, University of Queensland, Australia.,Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Benedict J Panizza
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Australia
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39
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Warren TA, Nagle CM, Bowman J, Panizza BJ. The Natural History and Treatment Outcomes of Perineural Spread of Malignancy within the Head and Neck. J Neurol Surg B Skull Base 2016; 77:107-12. [PMID: 27123386 PMCID: PMC4846401 DOI: 10.1055/s-0036-1579777] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Understanding the natural history of diseases enables the clinician to better diagnose and treat their patients. Perineural spread of head and neck cancers are poorly understood and often diagnosis is delayed resulting in poorer outcomes and more debilitating treatments. This article reviews a large personal series of head and neck malignancy presenting with perineural spread along almost exclusively the trigeminal and/or facial nerves. A detailed analysis of squamous cell carcinoma of cutaneous origin is presented including an analysis of likely primaries, which most often have occurred months to years prior. The importance of early detection is reinforced by the highly significant (p < 0.0001) differences in disease specific survival, which occur, depending on how far along a cranial nerve the disease has been allowed to spread.
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Affiliation(s)
- Timothy A. Warren
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Christina M. Nagle
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Public Health, University of Queensland, Brisbane, Australia
| | - James Bowman
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Benedict J. Panizza
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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40
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Amit M, Eran A, Billan S, Fridman E, Na'ara S, Charas T, Gil Z. Perineural Spread in Noncutaneous Head and Neck Cancer: New Insights into an Old Problem. J Neurol Surg B Skull Base 2016; 77:86-95. [PMID: 27123384 PMCID: PMC4846400 DOI: 10.1055/s-0036-1571834] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Head and neck malignancies have the propensity to invade nerves. Perineural tumor invasion is common, with some series reporting rates of 30 to 100%. Squamous cell carcinoma and adenoid cystic carcinoma are the most commonly involved tumors. The most commonly involved nerves are the trigeminal (cranial nerve [CN] V) and facial (CN VII) and their branches. Neural spread away from a tumor is encountered less often and usually causes specific symptoms such as pain, muscle weakness, and atrophy, depending on the involved nerves. While clinical symptoms and physical examination may suggest the presence of neural invasion, specific imaging modalities such as fat-suppressed T1-weighted magnetic resonance images, should be utilized to identify perineural tumor spread in its early phases. Perineural tumor spread should be considered and addressed in the treatment planning of patients with head and neck or skull base cancers as it can influence the extent of surgery, and the dosage and fields of radiation therapy. In the current review, we discuss the clinical course of perineural tumor spread and its therapeutic implications.
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Affiliation(s)
- Moran Amit
- The Laboratory for Applied Cancer Research, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
- The Head and Neck Center, Department of Otolaryngology-Head and Neck Surgery, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Ayelet Eran
- Department of Radiology, Rambam Healthcare Campus, Israel Institute of Technology, Haifa, Israel
| | - Salem Billan
- Department of Oncology, Rambam Healthcare Campus, Israel Institute of Technology, Haifa, Israel
| | - Eran Fridman
- The Laboratory for Applied Cancer Research, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
- The Head and Neck Center, Department of Otolaryngology-Head and Neck Surgery, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Shorook Na'ara
- The Laboratory for Applied Cancer Research, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
- The Head and Neck Center, Department of Otolaryngology-Head and Neck Surgery, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Tomer Charas
- Department of Oncology, Rambam Healthcare Campus, Israel Institute of Technology, Haifa, Israel
| | - Ziv Gil
- The Laboratory for Applied Cancer Research, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
- The Head and Neck Center, Department of Otolaryngology-Head and Neck Surgery, Rambam Healthcare Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
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41
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Solares CA, Mason E, Panizza BJ. Surgical Management of Perineural Spread of Head and Neck Cancers. J Neurol Surg B Skull Base 2016; 77:140-9. [PMID: 27123390 DOI: 10.1055/s-0036-1579751] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The surgical management of perineural spread of head and neck cancers has become an integral part in the contemporary treatment of this pathology. We now understand that tumour spreads within the epineurium and in a continuous fashion. We also can rely on the accuracy of magnetic resonance neurography in detecting and defining the extent of disease. With modern skull base techniques and a greater understanding of the anatomy in this region, specific operations can be designed to help eradicate disease. We review the current approaches and techniques used that enable us to better obtain tumour free margins and hence improve survival.
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Affiliation(s)
- C Arturo Solares
- Department of Otolaryngology, Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, United States; Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, United States
| | - Eric Mason
- Department of Otolaryngology, Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, United States; Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, United States
| | - Benedict J Panizza
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Australia
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42
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Redmond MJ, Panizza BJ. Intracranial Management of Perineural Spread in the Trigeminal Nerve. J Neurol Surg B Skull Base 2016; 77:150-60. [PMID: 27123391 DOI: 10.1055/s-0036-1571838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Since the mid-1960s surgeons have attempted to cure intracranial perineural spread (PNS) of cutaneous malignancies. Untreated patients with trigeminal PNS die from brainstem invasion and leptomeningeal disease. It was understood that resection with clear margins was potentially curative, but early surgical attempts were unsuccessful. The prevailing wisdom considered that this surgery failed to improve the results achieved with radiation therapy alone and was associated with high morbidity. However, with improved imaging, surgical equipment, and better understanding of cavernous sinus (CS) anatomy and access, contemporary surgeons can improve outcomes for this disease. The aim of this paper is to describe a technique to access the interdural compartment of the CS and treat PNS of cutaneous squamous cell carcinoma (cSCC) in the intracranial trigeminal nerve and ganglion. It is based on the experience of the Queensland Skull Base Unit, Australia in managing PNS of cutaneous squamous cell carcinoma of the head and neck (cSCCHN).
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Affiliation(s)
- Michael J Redmond
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Department of Neurosurgery, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia; Department of Surgery, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Benedict J Panizza
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Department of Surgery, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Australia
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Abstract
We present a review of the imaging findings of large nerve perineural spread within the skull base. The MRI techniques and reasons for performing different sequences are discussed. A series of imaging examples illustrates the appearance of perineural tumor spread with an emphasis on the zonal staging system.
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Affiliation(s)
- Mitesh Gandhi
- The Department of Radiology, Princess Alexandra Hospital and Queensland Xray, Brisbane, Australia
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Porceddu SV. Prognostic factors and the role of adjuvant radiation therapy in non-melanoma skin cancer of the head and neck. Am Soc Clin Oncol Educ Book 2016:e513-8. [PMID: 25993217 DOI: 10.14694/edbook_am.2015.35.e513] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-melanoma skin cancer (NMSC) is the most common cancer worldwide. Among the two types of NMSC, basal cell carcinoma (BCC) accounts for approximately 75% to 80% of cases and cutaneous squamous cell carcinoma (cSCC) accounts for 20% to 25% of cases. The majority of lesions are low risk and treated with simple surgical excision, which provides histopathologic information and is associated with high cure rates and acceptable cosmetic and functional outcomes. cSCCs are generally more aggressive than BCCs. NMSC commonly occurs in the sun-exposed head and neck region (80% to 90%). Approximately 5% of patients with NMSC (mainly cSCC) will have clinicopathologic features that predict for an increased risk for local and regional recurrence and, rarely, distant relapse. These features include locally advanced primary disease (stage T3-T4), regional nodal involvement, clinical perineural invasion, recurrent disease following treatment, and immunosuppression. Patients who have these features may warrant review by a multidisciplinary tumor board and might require combined modality treatment involving surgery and adjuvant radiation therapy (RT). This article focuses on our current understanding of the prognostic factors and role of adjuvant RT in high-risk NMSC of the head and neck.
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Affiliation(s)
- Sandro V Porceddu
- From the Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
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45
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Facial Paralysis Secondary to Extensive Perineural Spread of Adenocarcinoma of the Parotid Gland Identified by PET/CT. Clin Nucl Med 2016; 41:e301-3. [PMID: 26825200 DOI: 10.1097/rlu.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Brain MRI in an 82-year-old man with presumed Bell's palsy revealed a clinically unsuspected right parotid gland mass but no other acute findings. Biopsy revealed poorly differentiated adenocarcinoma. Staging F-FDG PET/CT revealed an FDG-avid parotid mass, abnormal FDG uptake along the course of the facial nerve from mass to skull base, and multiple FDG-avid right level II neck lymph nodes and hepatic metastases. The PET/CT findings and prolonged clinical course suggest that diffuse perineural spread of tumor from a smoldering parotid neoplasm, and not idiopathic Bell's palsy, was responsible for the patient's facial paralysis.
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Porceddu SV, Veness MJ, Guminski A. Nonmelanoma Cutaneous Head and Neck Cancer and Merkel Cell Carcinoma: Current Concepts, Advances, and Controversies. J Clin Oncol 2015; 33:3338-45. [PMID: 26351348 DOI: 10.1200/jco.2014.60.7333] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Nonmelanoma skin cancer (NMSC) is the most common cancer worldwide and the most frequently observed malignancy in whites. Approximately 75% to 80% are basal cell carcinomas and 20% to 25% are squamous cell carcinomas. Incidence is increasing, partly reflecting an ageing population, and NMSC is more commonly seen in men. The predominant causative agent is ultraviolet solar radiation exposure, with the majority of cases occurring on the head and neck. Surgical excision is typically the treatment of choice, providing histopathologic information, high cure rates, and acceptable cosmetic and functional outcomes. Radiation therapy is reserved for cases where surgery is not the preferred choice or for high-risk cases where adjuvant therapy is recommended. Although overall mortality rates are low, patients with complex cases such as those with immunosuppression should be considered for management within multidisciplinary tumor boards. In contrast, Merkel cell carcinoma is a rare and aggressive malignancy, frequently arising on the head and neck in older whites, with a poorer prognosis. This article focuses on the current evidence guiding practice, recent advances, and areas of controversy in NMSC and Merkel cell carcinoma of the head and neck.
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Affiliation(s)
- Sandro V Porceddu
- Sandro V. Porceddu, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland; Michael J. Veness, Westmead Cancer Cancer Centre; Michael J. Veness and Alexander Guminski, University of Sydney; and Alexander Guminski, Royal North Shore Hospital, Sydney, New South Wales, Australia.
| | - Michael J Veness
- Sandro V. Porceddu, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland; Michael J. Veness, Westmead Cancer Cancer Centre; Michael J. Veness and Alexander Guminski, University of Sydney; and Alexander Guminski, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alexander Guminski
- Sandro V. Porceddu, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland; Michael J. Veness, Westmead Cancer Cancer Centre; Michael J. Veness and Alexander Guminski, University of Sydney; and Alexander Guminski, Royal North Shore Hospital, Sydney, New South Wales, Australia
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48
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Baulch J, Gandhi M, Sommerville J, Panizza B. 3T MRI evaluation of large nerve perineural spread of head and neck cancers. J Med Imaging Radiat Oncol 2015; 59:578-85. [DOI: 10.1111/1754-9485.12338] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/16/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Justin Baulch
- Department of Radiology; Princess Alexandra Hospital; Brisbane Queensland Australia
- QScan Radiology Clinics; Brisbane Queensland Australia
| | - Mitesh Gandhi
- Department of Radiology; Princess Alexandra Hospital; Brisbane Queensland Australia
- Queensland X-Ray; Brisbane Queensland Australia
| | - Jennifer Sommerville
- Department of Radiology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Ben Panizza
- Queensland Skull Base Unit; Princess Alexandra Hospital and the School of Medicine; University of Queensland; Brisbane Queensland Australia
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49
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Li Y, Zhang XA, Qi S. Anatomic characteristics of the dural sheath of the trigeminal nerve. Head Neck 2015; 38 Suppl 1:E185-8. [PMID: 25537968 DOI: 10.1002/hed.23968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yilei Li
- Department of Pharmacology, Nanfang Hospital; Southern Medical University; Guangzhou Guangdong People's Republic of China
| | - Xi-an Zhang
- Department of Neurosurgery, Nanfang Hospital; Southern Medical University; Guangzhou Guangdong People's Republic of China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital; Southern Medical University; Guangzhou Guangdong People's Republic of China
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50
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Warren TA, Panizza B, Porceddu SV, Gandhi M, Patel P, Wood M, Nagle CM, Redmond M. Outcomes after surgery and postoperative radiotherapy for perineural spread of head and neck cutaneous squamous cell carcinoma. Head Neck 2015; 38:824-31. [PMID: 25546817 DOI: 10.1002/hed.23982] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/18/2014] [Accepted: 12/18/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Queensland, Australia, has the highest rates of cutaneous squamous cell carcinoma (SCC). Perineural invasion (PNI) is associated with reduced local control and survival. METHODS A retrospective review of a prospective database of patients with clinical PNI from cutaneous SCC of the head and neck (SCCHN) treated with surgery and postoperative radiotherapy (PORT) between 2000 and 2011 and a minimum of 24 months follow-up. Patients were excluded if immunosuppressed, had non-SCC histology, or were treated palliatively. RESULTS Fifty patients (mean age, 60 years) with median follow-up of 50 months were included in this study. A total of 54.8% of known primary tumors had incidental PNI. Ten percent had nodal disease at presentation. MRI neurogram was positive in 95.8%. Recurrence-free survival (RFS) at 5-years was 62%. Five-year disease-specific survival (DSS) and overall survival (OS) were 75% and 64%, respectively. There were no perioperative deaths. CONCLUSION This report demonstrates that long-term survival is achievable in patients with clinical PNI from cutaneous SCCHN after surgery and PORT. © 2015 Wiley Periodicals, Inc. Head Neck 38: 824-831, 2016.
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Affiliation(s)
- Timothy A Warren
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Benedict Panizza
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Australia
| | - Sandro V Porceddu
- School of Medicine, University of Queensland, Australia.,Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mitesh Gandhi
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Parag Patel
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Martin Wood
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Michael Redmond
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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