title: Perineural spread of cutaneous malignancy to the brain: a review of the literature and five patients treated with stereotactic radiotherapy.
abstract: BACKGROUND
  The retrospective analysis was performed to investigate the role of stereotactic radiotherapy (SRT) techniques for patients with intracranial perineural spread (PNS) of a primary cutaneous malignancy.
  
  
  METHODS
  Five patients were identified who received SRT from 1993 to 2003 for cutaneous malignancies with intracranial PNS to the cavernous sinus (n = 3) or Meckel's cave (n = 2). Patients were treated with GammaKnife stereotactic radiosurgery (n = 2), linear accelerator (linac)-based fractionated SRT (n = 2), or linac-based stereotactic radiosurgery (n = 1).
  
  
  RESULTS
  The median overall survival (OS) periods from diagnoses of cutaneous malignancy and intracranial PNS were 63.0 months (range, 22.0-102.2 months) and 25.5 months (range, 22.0-55.2 months), respectively. The median OS from SRT was 24.2 months (range, 19.5-53.2 months). One patient was alive and without evidence of disease at 53 months of follow-up. The median durations of local and regional control from SRT were 19.5 months (range, 1.5-53.2 months) and 7.0 months (range, 1.5-53.2 months), respectively.
  
  
  CONCLUSIONS
  Previous reports generally have recommended that patients with intracranial PNS receive palliative external-beam radiotherapy. Results from the current study suggest that some of these patients may have prolonged survival, or even may be cured. Judicious use of SRT should be considered in their management.
authors.affiliation: Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: B Zach
authors.initials: BZ
authors.lastname: Fowler
authors.forename: Ian R
authors.initials: IR
authors.lastname: Crocker
authors.forename: Peter A S
authors.initials: PA
authors.lastname: Johnstone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery; D003391:Cranial Nerves / Q000473:pathology*; D018572:Disease-Free Survival; D017809:Fatal Outcome; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D016634:Radiosurgery / Q000295:instrumentation; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D015996:Survival Rate