Should Perineural Invasion Warrant Adjuvant Therapy in Surgically Treated Head and Neck Cancer

  • Warren C. Swegal
  • Farzan Siddiqui
  • Steven S. Chang
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Head and neck tumors with aggressive features often have an increased risk of locoregional recurrence. Perineural invasion (PNI) is one such adverse feature that may warrant adjuvant treatment after surgical resection. In this chapter, we will discuss the effect of PNI on locoregional control and when adjuvant therapy may or may not be beneficial. The chapter is divided between histologic subtypes of head and neck cancer and include mucosal squamous cell carcinoma (mSCC), cutaneous squamous cell carcinoma (cSCC), and salivary gland cancer. Overall, the literature is limited when it comes to prospective studies which focus on PNI as the dedicated variable. For cSCC, there is a lack of evidence to suggest that adjuvant radiotherapy can be de-escalated, and its use should continue for tumors with PNI. Regarding salivary gland cancer, adenoid cystic carcinoma was the most widely studied and there is evidence to suggest that adjuvant therapy may be beneficial in reducing risk of recurrence. Lastly, there is not sufficient evidence for PNI in mSCC to suggest that surgery alone is equivocal to surgery and adjuvant radiotherapy. The lack of prospective trials greatly limits the recommendations that can be made regarding treatment decisions.


Perineural invasion Mucosal squamous cell carcinoma Cutaneous squamous cell carcinoma Salivary gland carcinoma Adverse features 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Warren C. Swegal
    • 1
  • Farzan Siddiqui
    • 2
  • Steven S. Chang
    • 1
  1. 1.Department of Otolaryngology-Head and Neck SurgeryHenry Ford HospitalDetroitUSA
  2. 2.Department of Radiation OncologyHenry Ford HospitalDetroitUSA

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