Patterson John D, Helton Matthew, Khani Mehdi, Sardar Sehrish, Thomas Kevin, Galhardo Edvaldo P, Penagaricano Jose A, Day John D, Rodriguez Analiz
Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Surg Neurol Int. 2020 Jul 25;11:206. doi: 10.25259/SNI_146_2020. eCollection 2020.
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.
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.
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.
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.
神经周围浸润（PNI）及扩散是与原发性皮肤癌和头颈癌相关的最严峻的预后因素之一，但仍是一种常被混淆且报告不足的现象。使神经周围扩散（PNS）的诊断和治疗变得复杂的是，发现患者可能没有已知的原发性肿瘤、皮肤癌病史和/或原发性肿瘤中的偶然PNI。疾病进程本就缓慢，这些诊断和治疗上的延迟进一步加剧，通常需要立体定向放射外科、手术切除以及诸如检查点抑制剂等新型治疗方法相结合的多学科护理。
选择6例接受伽玛刀放射外科（GKRS）治疗的颅神经转移性癌患者进行回顾性分析。这些信息包括年龄、性别、既往任何手术（立体定向手术和常规手术）、GKRS治疗中的放射剂量和肿瘤体积、PNS日期、合并症、患者随访情况以及GKRS治疗前后的影像学检查。通过影像学检查进行随访的目的是评估GKRS的疗效。
介绍了6例PNS患者的临床病程。患者的病程各不相同，结果各异：2例患者仍存活，1例失访，3例死亡，自诊断之日起的中位生存期为12个月。我们机构的患者理想情况下应进行终身随访。
鉴于癌症PNS的发病率和死亡率，时间有限，需要进一步了解以改善治疗结果。在此，我们提供了一组接受立体定向放射外科治疗的PNS患者病例系列，讨论了他们的临床病程，并回顾了相关文献。
