Advertisement

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

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

Abstract

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.

Keywords

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

References

  1. 1.
    Leibovitch I, Huilgol SC, Selva D, Hill D, Richards S, Paver R. Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years. J Am Acad Dermatol. 2005;53(2):253–60.CrossRefGoogle Scholar
  2. 2.
    Soo KC, Carter RL, O’Brien CJ, Barr L, Bliss JM, Shaw HJ. Prognostic implications of perineural spread in squamous carcinomas of the head and neck. Laryngoscope. 1986;96(10):1145–8.CrossRefGoogle Scholar
  3. 3.
    Ali S, Palmer FL, Katabi N, et al. Long-term local control rates of patients with adenoid cystic carcinoma of the head and neck managed by surgery and postoperative radiation. Laryngoscope. 2017;127(10):2265–9.CrossRefGoogle Scholar
  4. 4.
    Tai SK, Li WY, Yang MH, et al. Treatment for T1-2 oral squamous cell carcinoma with or without perineural invasion: neck dissection and postoperative adjuvant therapy. Ann Surg Oncol. 2012;19(6):1995–2002.CrossRefGoogle Scholar
  5. 5.
    Chatzistefanou I, Lubek J, Markou K, Ord RA. The role of neck dissection and postoperative adjuvant radiotherapy in cN0 patients with PNI-positive squamous cell carcinoma of the oral cavity. Oral Oncol. 2014;50(8):753–8.CrossRefGoogle Scholar
  6. 6.
    Rahima B, Shingaki S, Nagata M, Saito C. Prognostic significance of perineural invasion in oral and oropharyngeal carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97(4):423–31.CrossRefGoogle Scholar
  7. 7.
    Jardim JF, Francisco AL, Gondak R, Damascena A, Kowalski LP. Prognostic impact of perineural invasion and lymphovascular invasion in advanced stage oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2015;44(1):23–8.CrossRefGoogle Scholar
  8. 8.
    Carter JB, Johnson MM, Chua TL, Karia PS, Schmults CD. Outcomes of primary cutaneous squamous cell carcinoma with perineural invasion: an 11-year cohort study. JAMA Dermatol. 2013;149(1):35–41.CrossRefGoogle Scholar
  9. 9.
    Ross AS, Whalen FM, Elenitsas R, Xu X, Troxel AB, Schmults CD. Diameter of involved nerves predicts outcomes in cutaneous squamous cell carcinoma with perineural invasion: an investigator-blinded retrospective cohort study. Dermatol Surg. 2009;35(12):1859–66.CrossRefGoogle Scholar
  10. 10.
    Fagan JJ, Collins B, Barnes L, D’Amico F, Myers EN, Johnson JT. Perineural invasion in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 1998;124(6):637–40.CrossRefGoogle Scholar
  11. 11.
    Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350(19):1945–52.CrossRefGoogle Scholar
  12. 12.
    Vikram B, Strong EW, Shah JP, Spiro R. Failure in the neck following multimodality treatment for advanced head and neck cancer. Head Neck Surg. 1984;6(3):724–9.CrossRefGoogle Scholar
  13. 13.
    Kramer S, Gelber RD, Snow JB, et al. Combined radiation therapy and surgery in the management of advanced head and neck cancer: final report of study 73-03 of the Radiation Therapy Oncology Group. Head Neck Surg. 1987;10(1):19–30.CrossRefGoogle Scholar
  14. 14.
    Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005;27(10):843–50.CrossRefGoogle Scholar
  15. 15.
    Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350(19):1937–44.CrossRefGoogle Scholar
  16. 16.
    Le Tourneau C, Jung GM, Borel C, Bronner G, Flesch H, Velten M. Prognostic factors of survival in head and neck cancer patients treated with surgery and postoperative radiation therapy. Acta Otolaryngol. 2008;128(6):706–12.CrossRefGoogle Scholar
  17. 17.
    Fan KH, Wang HM, Kang CJ, et al. Treatment results of postoperative radiotherapy on squamous cell carcinoma of the oral cavity: coexistence of multiple minor risk factors results in higher recurrence rates. Int J Radiat Oncol Biol Phys. 2010;77(4):1024–9.CrossRefGoogle Scholar
  18. 18.
    Ferris RL, Geiger JL, Trivedi S, et al. Phase II trial of post-operative radiotherapy with concurrent cisplatin plus panitumumab in patients with high-risk, resected head and neck cancer. Ann Oncol. 2016;27(12):2257–62.CrossRefGoogle Scholar
  19. 19.
    Argiris A, Karamouzis MV, Johnson JT, et al. Long-term results of a phase III randomized trial of postoperative radiotherapy with or without carboplatin in patients with high-risk head and neck cancer. Laryngoscope. 2008;118(3):444–9.CrossRefGoogle Scholar
  20. 20.
    Liao CT, Chang JT, Wang HM, et al. Does adjuvant radiation therapy improve outcomes in pT1-3N0 oral cavity cancer with tumor-free margins and perineural invasion? Int J Radiat Oncol Biol Phys. 2008;71(2):371–6.CrossRefGoogle Scholar
  21. 21.
    Chinn SB, Spector ME, Bellile EL, et al. Impact of perineural invasion in the pathologically N0 neck in oral cavity squamous cell carcinoma. Otolaryngology Head Neck Surg. 2013;149(6):893–9.CrossRefGoogle Scholar
  22. 22.
    Creighton F, Lin A, Leavitt E, Lin D, Deschler D, Emerick K. Factors affecting survival and locoregional control in head and neck cSCCA with nodal metastasis. Laryngoscope. 2018;128(8):1881–6.CrossRefGoogle Scholar
  23. 23.
    Jackson JE, Dickie GJ, Wiltshire KL, et al. Radiotherapy for perineural invasion in cutaneous head and neck carcinomas: toward a risk-adapted treatment approach. Head Neck. 2009;31(5):604–10.CrossRefGoogle Scholar
  24. 24.
    Mendenhall WM, Amdur RJ, Hinerman RW, et al. Skin cancer of the head and neck with perineural invasion. Am J Clin Oncol. 2007;30(1):93–6.CrossRefGoogle Scholar
  25. 25.
    Harris BN, Bayoumi A, Rao S, Moore MG, Farwell DG, Bewley AF. Factors associated with recurrence and regional adenopathy for head and neck cutaneous squamous cell carcinoma. Otolaryngol Head Neck Surg. 2017;156(5):863–9.CrossRefGoogle Scholar
  26. 26.
    Mendenhall WM, Ferlito A, Takes RP, et al. Cutaneous head and neck basal and squamous cell carcinomas with perineural invasion. Oral Oncol. 2012;48(10):918–22.CrossRefGoogle Scholar
  27. 27.
    Panizza B, Warren TA, Solares CA, Boyle GM, Lambie D, Brown I. Histopathological features of clinical perineural invasion of cutaneous squamous cell carcinoma of the head and neck and the potential implications for treatment. Head Neck. 2014;36(11):1611–8.CrossRefGoogle Scholar
  28. 28.
    Panizza B, Solares CA, Redmond M, Parmar P, O’Rourke P. Surgical resection for clinical perineural invasion from cutaneous squamous cell carcinoma of the head and neck. Head Neck. 2012;34(11):1622–7.CrossRefGoogle Scholar
  29. 29.
    Han A, Ratner D. What is the role of adjuvant radiotherapy in the treatment of cutaneous squamous cell carcinoma with perineural invasion? Cancer. 2007;109(6):1053–9.CrossRefGoogle Scholar
  30. 30.
    Amit M, Binenbaum Y, Trejo-Leider L, et al. International collaborative validation of intraneural invasion as a prognostic marker in adenoid cystic carcinoma of the head and neck. Head Neck. 2015;37(7):1038–45.CrossRefGoogle Scholar
  31. 31.
    Chen AM, Bucci MK, Weinberg V, et al. Adenoid cystic carcinoma of the head and neck treated by surgery with or without postoperative radiation therapy: prognostic features of recurrence. Int J Radiat Oncol Biol Phys. 2006;66(1):152–9.CrossRefGoogle Scholar
  32. 32.
    Chen AM, Garcia J, Granchi P, Bucci MK, Lee NY. Base of skull recurrences after treatment of salivary gland cancer with perineural invasion reduced by postoperative radiotherapy. Clin Otolaryngol. 2009;34(6):539–45.CrossRefGoogle Scholar
  33. 33.
    Hsieh CE, Lin CY, Lee LY, et al. Adding concurrent chemotherapy to postoperative radiotherapy improves locoregional control but not overall survival in patients with salivary gland adenoid cystic carcinoma-a propensity score matched study. Radiat Oncol. 2016;11:47.CrossRefGoogle Scholar

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

Personalised recommendations