头颈部皮肤鳞状细胞癌中低危和高危神经周围侵犯的放射治疗：临床结果和失败模式。

Radiation therapy for low- and high-risk perineural invasion in head and neck cutaneous squamous cell carcinoma: Clinical outcomes and patterns of failure.

机构信息

Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, Washington, USA.

Department of Radiation Oncology, University of Washington, Seattle, Washington, USA.

出版信息

Head Neck. 2023 Sep;45(9):2323-2334. doi: 10.1002/hed.27458. Epub 2023 Jul 14.

DOI:10.1002/hed.27458

PMID:37448346

Abstract

BACKGROUND

Perineural invasion (PNI) in head and neck squamous cell carcinoma (HNSCC) portends poor prognosis. Extent of treatment of nerve pathways with varying degrees of PNI and patterns of failure following elective neural radiotherapy (RT) remain unclear.

METHODS

Retrospective review of HNSCC patients with high-risk (clinical/gross, large-nerve, extensive) or low-risk (microscopic/focal) PNI who underwent curative-intent treatment from 2010 to 2021.

RESULTS

Forty-four patients (mean follow-up 22 months; 59% high-risk, 41% low-risk PNI) were included. Recurrence following definitive treatment occurred in 31% high-risk and 17% low-risk PNI patients. Among high-risk patients, 69% underwent surgery with post-operative RT and 46% underwent elective neural RT. Local control (83% low-risk vs. 75% high-risk), disease-free, and overall survival did not differ between groups.

CONCLUSIONS

High local control rates were achieved in high-risk PNI patients treated with adjuvant or primary RT, including treatment of both involved and uninvolved, communicating cranial nerves, with few failures in electively treated regions.

摘要

背景

头颈部鳞状细胞癌（HNSCC）中的神经周围侵犯（PNI）预示着预后不良。对于有不同程度 PNI 的神经通路的治疗范围以及选择性神经放射治疗（RT）后的失败模式仍不清楚。

方法

回顾性分析了 2010 年至 2021 年间接受根治性治疗的高风险（临床/大体，大神经，广泛）或低风险（显微镜/局灶）PNI 的 HNSCC 患者。

结果

共纳入 44 例患者（平均随访 22 个月；59%高风险 PNI，41%低风险 PNI）。在确定性治疗后，高风险 PNI 患者中有 31%和低风险 PNI 患者中有 17%出现复发。在高风险患者中，69%接受了手术联合术后 RT，46%接受了选择性神经 RT。两组间局部控制率（低风险为 83%，高风险为 75%）、无病生存率和总生存率无差异。