Williams L S, Mancuso A A, Mendenhall W M
Department of Radiology, University of Florida, Gainesville, FL 32610-0374, USA.
Int J Radiat Oncol Biol Phys. 2001 Mar 15;49(4):1061-9. doi: 10.1016/s0360-3016(00)01407-3.
To analyze the pretreatment imaging findings and outcome of patients with perineural spread of squamous or basal cell carcinoma of the face and scalp treated with radiotherapy, to determine whether CT (computed tomography) or MR (magnetic resonance) imaging can be effectively used to identify patients who would benefit from aggressive treatment, and to characterize the imaging features associated with cure.
Thirty-five patients had perineural spread of squamous and basal cell carcinoma along the divisions of the trigeminal and/or facial nerves based on clinical findings and/or histopathological proof. Perineural extension seen on imaging was divided into three zones of involvement. The volume of perineural disease was graded semiquanitatively. All patients received radiotherapy with curative intent.
Eighteen of the 35 patients had imaging evidence of perineural spread of tumor, and the remaining 17 were imaging negative for perineural spread. The absolute 5-year survival of the imaging positive group was 50% compared with 86% in the imaging-negative group (p = 0.048).
Imaging can be used to identify patients with advanced perineural spread who warrant aggressive radiotherapy. Imaging evidence of perineural invasion worsens prognosis; however, low-volume and peripheral perineural disease is radiocurable. Greater perineural tumor volume with more central disease was associated with an unfavorable outcome.
分析接受放射治疗的面部和头皮鳞状或基底细胞癌伴神经周围扩散患者的治疗前影像学表现及预后，确定计算机断层扫描（CT）或磁共振成像（MR）是否能有效用于识别可从积极治疗中获益的患者，并描述与治愈相关的影像学特征。
35例患者根据临床表现和/或组织病理学证据，存在鳞状和基底细胞癌沿三叉神经和/或面神经分支的神经周围扩散。影像学上可见的神经周围扩展分为三个受累区域。神经周围病变的体积进行半定量分级。所有患者均接受根治性放疗。
35例患者中，18例有肿瘤神经周围扩散的影像学证据，其余17例神经周围扩散影像学检查为阴性。影像学阳性组的5年绝对生存率为50%，而影像学阴性组为86%（p = 0.048）。
影像学可用于识别需要积极放疗的晚期神经周围扩散患者。神经周围侵犯的影像学证据会使预后恶化；然而，小体积和外周神经周围病变是可放疗治愈的。神经周围肿瘤体积越大且病变越靠近中心，预后越差。
