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Crawford L, Bowman J, Gandhi M, Porceddu SV, Panizza B. Clinical outcomes in perineural spread of cutaneous squamous cell carcinoma via the ophthalmic nerve. Head Neck 2024; 46:2214-2222. [PMID: 39031796 DOI: 10.1002/hed.27836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/19/2024] [Accepted: 05/27/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND There are no large studies reporting oncological or survival outcomes for patients diagnosed with perineural spread (PNS) of cutaneous squamous cell carcinoma (cSCC) via the ophthalmic nerve (V1). Where orbital exenteration may be necessary for curative treatment, it is critical to have survival data with which the morbidity associated with surgical treatment can be justified. Furthermore, with the emerging treatment option of immunotherapy, current standard of care outcomes are needed to help guide future trial design and eventually changed management guidelines. OBJECTIVE To determine the oncological and survival outcomes observed in patients with PNS of cSCC via V1. MATERIALS AND METHODS Retrospective analysis of prospectively maintained cohort of patients with PNS of cSCC via V1 treated in a tertiary Australian head and neck oncology/skull base referral center. Consecutive sample of 53 patients managed between March 1, 1999 and April 30, 2020. Follow-up closure date was September 1, 2021. Curative-intent surgery, curative-intent radiotherapy, or palliative care was undertaken. Endpoints included five-year overall, disease-specific, and disease-free survival from the date of treatment. RESULTS Five-year Kaplan-Meier overall survival was 61.9% (95% CI 46.2%-74.3%), with disease-specific survival of 74.6% (95% CI 58.8%-85.3%), and disease-free survival 62.1% (95% CI 46.5%-74.3%). Survival was superior in patients treated via surgery and adjuvant radiotherapy than in those receiving surgery alone or definitive radiotherapy. Survival was superior among patients with less advanced disease as assessed by the Williams zonal staging system; patients with Zone 1 disease had disease-specific survival of 94.1% at 5 years with 82.5% disease-free survival. DISCUSSION Five-year oncological and survival outcomes in this cohort were favorable. Superior survival was observed in patients treated with curative-intent surgery and adjuvant radiotherapy. Less extensive disease as delineated by the Williams zonal staging system was associated with improved survival. CONCLUSION Surgical resection with adjuvant radiotherapy confers favourable oncological and survival outcome in patients with V1 PNS, particularly with early disease limited to Zone 1.
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Affiliation(s)
- Lachlan Crawford
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - James Bowman
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mitesh Gandhi
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sandro V Porceddu
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Benedict Panizza
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Zárate-García JP, Ortega-Porcayo LA, Tejada-Pineda MF, Moscardini-Martelli J, Romano-Feinholz S, Ponce-Gómez JA, Osuna-Zazueta MA, Zárate-García AN, Guillén-Camacho ME, Jiménez SM. Perineural Invasion of Cranial Nerves in Cutaneous Squamous Cell Carcinoma: Unraveling Its Complexities, Diagnostic Challenges, and Multifaceted Treatment Approaches. Cureus 2024; 16:e61854. [PMID: 38978946 PMCID: PMC11227979 DOI: 10.7759/cureus.61854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/10/2024] Open
Abstract
Cutaneous squamous cell carcinoma is the second most common neoplasm among non-melanoma skin cancers. When associated with perineural invasion of the cranial nerves, with clinical features often observed in trigeminal and facial nerves due to their cutaneous extension, it may lead to a worse prognosis. This paper introduces a rare case of an 81-year-old male, with a history of a moderately differentiated invasive carcinoma of the left frontal region with perineural invasion on the left trigeminal cranial nerve. The case underscores the aggressive nature of the intraneural infiltration by squamous cell carcinoma and the challenges in managing such advanced malignancies.
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Affiliation(s)
| | | | | | - Júlia Moscardini-Martelli
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Samuel Romano-Feinholz
- Department of Neurosurgery, American British Cowdray (ABC) Medical Center, Mexico City, MEX
| | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Alexa Natalia Zárate-García
- School of Medicine and Health Sciences, Facultad Mexicana de Medicina Universidad La Salle, Mexico City, MEX
| | | | - Sergio M Jiménez
- Radiosurgery Unit, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico City, MEX
- Department of Neurosurgery-Radiosurgery, American British Cowdray (ABC) Medical Center, Mexico City, MEX
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Kinger NP, Chien LC, Sharma PS, Gravolet RB, Aiken AH, Baugnon KL, Wu X. Comparison of 3D constructive interference in steady state (CISS) and T2 sampling perfection with application optimized contrasts using different flip angle evolution MR imaging of the intracranial trigeminal nerve and central skull base neuroforamina. Neuroradiol J 2022; 35:678-683. [PMID: 35400223 PMCID: PMC9626844 DOI: 10.1177/19714009221084248] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Due to surgical advancements, the accurate detection of perineural disease spread has become increasingly important in the management and prognostication of head and neck cancers, though MR evaluation has thus far been limited by technical and logistic challenges. The purpose of this study was to specifically evaluate the relative capability of 3D CISS and 3D T2-SPACE imaging to delineate the proximal intracranial divisions of the normal trigeminal nerve, an area important in determining the resectability of intracranial perineural disease. MATERIALS AND METHODS A single center HIPAA-compliant, IRB approved retrospective review of 40 patients with clinical temporal bone/internal auditory canal MR imaging was conducted. 20 patients with 3D CISS images and 20 patients with 3D T2-SPACE images met inclusion criteria. Two radiologists scored the sequences on a 3-point scale based on ability to visualize anatomic structures surrounding the trigeminal nerve in Meckel's cave, intracranial trigeminal divisions, skull base neuroforamina, and proximal extracranial mandibular division. RESULTS The following anatomic locations scored significantly better in the T2-SPACE sequence compared to the CISS sequence for both raters: intracranial V3 (p < .05), foramen ovale (p < .05), and extracranial V3 (p < .01). The average scores for the anterior Meckel's cave and foramen rotundum were higher for the T2-SPACE sequence, although not significantly. Percent interobserver agreement ranged from 50 to 90% and 65-100% for the different anatomic locations on the CISS and T2-SPACE sequences, respectively. CONCLUSION 3D T2-SPACE was found to be superior to 3D CISS in the evaluation of the distal intracranial and extracranial portions of the normal trigeminal nerve.
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Affiliation(s)
- Nikhar P Kinger
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ling-Chen Chien
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Puneet S Sharma
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ryan B Gravolet
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ashley H Aiken
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristen L Baugnon
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Xin Wu
- Department of Radiology and Imaging
Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Ferini G, Palmisciano P, Forte S, Viola A, Martorana E, Parisi S, Valenti V, Fichera C, Umana GE, Pergolizzi S. Advanced or Metastatic Cutaneous Squamous Cell Carcinoma: The Current and Future Role of Radiation Therapy in the Era of Immunotherapy. Cancers (Basel) 2022; 14:1871. [PMID: 35454779 PMCID: PMC9032290 DOI: 10.3390/cancers14081871] [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: 03/11/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 02/05/2023] Open
Abstract
Radiation therapy (RT) is an effective therapeutic option for small localized cutaneous squamous cell carcinoma (cSCC) among patients who are not eligible for or refuse surgery. RT also has a defined role as an adjuvant treatment in cases of adverse features that predispose to tumor recurrence after local excision. Since the development of cSCC is often a late consequence of chronic sun exposure, its occurrence is more common among elderly patients whose comorbidities may contraindicate surgical procedures. These could be impeded not only by frail medical conditions but also by technical issues. Indeed, an aggressive locoregional behavior of cSCC may culminate in unresectability due to widespread invasion of neighboring tissues. Moreover, cSCC could develop distant metastases. Both locally advanced and metastatic cSCCs carry a poor prognosis. In these scenarios, recent discoveries of tumor molecular targets are promoting the use of promising systemic therapies, especially immunotherapy, over RT. However, the results from using immunotherapy and, even more so, of chemotherapy are still not optimal. By contrast, advances in radiation delivery equipment can safely treat even large and complex-shaped cSCC targets in challenging body sites. In addition, RT could also have a role in metastatic cSCC settings by enhancing the effectiveness of concomitant immunotherapy. The aim of this review is to summarize and comment on the body of literature about the use of radiotherapy for operable and inoperable locally advanced cSCCs and for metastatic ones in an attempt to define its current and future role.
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Affiliation(s)
- Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, Italy;
| | | | - Stefano Forte
- IOM Ricerca srl, Via Penninazzo 11, 95029 Viagrande, Italy; (S.F.); (E.M.)
| | - Anna Viola
- Fondazione Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy;
| | - Emanuele Martorana
- IOM Ricerca srl, Via Penninazzo 11, 95029 Viagrande, Italy; (S.F.); (E.M.)
| | - Silvana Parisi
- Radiation Oncology Unit—Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98100 Messina, Italy; (S.P.); (S.P.)
| | - Vito Valenti
- Department of Radiation Oncology, REM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, Italy;
| | - Corrado Fichera
- Department of Plastic Surgery, Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy;
| | - Giuseppe Emmanuele Umana
- Trauma and Gamma-Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Stefano Pergolizzi
- Radiation Oncology Unit—Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98100 Messina, Italy; (S.P.); (S.P.)
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Management of advanced adenoid cystic carcinoma infiltrating the skull base: a contemporary review. J Neurooncol 2020; 150:419-427. [PMID: 31897924 DOI: 10.1007/s11060-019-03366-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This article provides an overview of the natural history and management of adenoid cystic carcinoma infiltrating the skull base (SB ACC). METHODS A comprehensive review of the available literature and discussion regarding the current management of SB ACC. RESULTS This review describes the unique pathology, appropriate diagnostic work-up and contemporary management options in SB ACC. There is a specific focus on the role of surgical resection with post-operative radiotherapy, given the literature suggesting a superior locoregional control rate. The importance of surgical decision making and varying surgical approaches are detailed. In addition, the emerging role of biological agents is discussed. CONCLUSION The gold standard for SB ACC is surgical resection and post-operative radiation, given the superior locoregional control. In patients not amendable to surgery, palliative radiation should be considered. The role of biological agents is still evolving. The complexity of SB ACC management mandates experienced multi-speciality management.
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Invasión perineural en el carcinoma epidermoide cutáneo. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:426-433. [DOI: 10.1016/j.ad.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/29/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023] Open
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Pérez García M, Mateu Puchades A, Sanmartín Jiménez O. Perineural Invasion in Cutaneous Squamous Cell Carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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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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