Wu Michael P, Reinshagen Katherine L, Cunnane Mary B, Shalhout Sophia Z, Kaufman Howard L, Miller David, Emerick Kevin S
Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.
Laryngoscope. 2022 Jun;132(6):1213-1218. doi: 10.1002/lary.29953. Epub 2021 Nov 19.
OBJECTIVES/HYPOTHESIS: To describe outcomes of advanced head and neck cutaneous squamous cell carcinoma (cSCC) with clinical perineural invasion (cPNI) treated with immune checkpoint inhibitor (ICI) therapy, and to describe post-treatment radiographic findings in the context of clinical response to treatment using a new grading system.
Retrospective chart review.
Retrospective chart review was performed for 11 patients treated with ICI for head and neck cSCC with cPNI of large named nerves. The primary outcome was response to treatment as defined by radiographic and clinical evidence. Clinical responses were defined as improvement in symptoms of neuropathic pain, hypoesthesia, nerve weakness, or decrease in visible tumor. Imaging studies were graded based on a new classification system for perineural invasion and reviewed by two neuroradiologists since RECISTv1.1 is inadequate to adjudicate response in these patients.
Nine (82%) patients had radiographic perineural disease control on ICI. Eight patients had improved radiographic perineural disease and one had stable disease. Of these, complete resolution of radiographic evidence of perineural disease was seen in only one patient. Seven (64%) patients had clinical responses, with either improved or stable radiographic disease.
ICI therapy is a viable treatment option for head and neck cSCC with cPNI. Radiographic and clinical evidence of response correlate well, with improvement in neuropathic pain being the most sensitive clinical marker of response. Even with favorable findings on repeat imaging and stable clinical course, complete resolution of perineural thickening and enhancement is rare. A grading system for classifying changes in perineural disease over time is proposed.
4 Laryngoscope, 132:1213-1218, 2022.
目的/假设：描述接受免疫检查点抑制剂（ICI）治疗的伴有临床神经周围侵犯（cPNI）的晚期头颈部皮肤鳞状细胞癌（cSCC）的治疗结果，并使用一种新的分级系统描述在治疗临床反应背景下的治疗后影像学表现。
回顾性病历审查。
对11例接受ICI治疗的伴有大命名神经cPNI的头颈部cSCC患者进行回顾性病历审查。主要结局是根据影像学和临床证据定义的治疗反应。临床反应定义为神经性疼痛、感觉减退、神经无力症状改善或可见肿瘤缩小。影像学研究根据一种新的神经周围侵犯分类系统进行分级，并由两名神经放射科医生进行审查，因为RECISTv1.1不足以判定这些患者的反应。
9例（82%）患者的ICI治疗使影像学神经周围疾病得到控制。8例患者的影像学神经周围疾病有所改善，1例病情稳定。其中，仅1例患者神经周围疾病的影像学证据完全消失。7例（64%）患者有临床反应，影像学疾病改善或稳定。
ICI治疗是伴有cPNI的头颈部cSCC的一种可行治疗选择。反应的影像学和临床证据相关性良好，神经性疼痛改善是最敏感的临床反应标志物。即使重复影像学检查结果良好且临床病程稳定，神经周围增厚和强化完全消失也很少见。提出了一种对神经周围疾病随时间变化进行分类的分级系统。
4 《喉镜》，132:1213 - 1218，2022年。
