title: Skin carcinoma of the head and neck with perineural invasion.
abstract: OBJECTIVE
  The aim of the study was to update the experience treating cutaneous squamous cell and basal cell carcinomas of the head and neck with incidental or clinical perineural invasion (PNI) with radiotherapy (RT).
  
  
  METHODS
  From 1965 to 2007, 216 patients received RT alone or with surgery and/or chemotherapy.
  
  
  RESULTS
  The 5-year overall, cause-specific, and disease-free survivals for incidental and clinical PNIs were 55% vs 54%, 73% vs 64%, and 67% vs 51%. The 5-year local control, local-regional control, and freedom from distant metastases for incidental and clinical PNIs were 80% vs 54%, 70% vs 51%, and 90% vs 94%. On univariate and multivariate (P = .0038 and .0047) analyses, clinical PNI was a poor prognostic factor for local control. The rates of grade 3 or higher complication in the incidental and clinical PNI groups were 16% and 36%, respectively.
  
  
  CONCLUSIONS
  Radiotherapy plays a critical role in the treatment of this disease. Clinical PNI should be adequately irradiated to include the involved nerves to the skull base.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Balamucki
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Mancuso
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Kirwan
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Franklin P
authors.initials: FP
authors.lastname: Flowers
authors.forename: Charles B
authors.initials: CB
authors.lastname: Stoer
authors.forename: Armand B
authors.initials: AB
authors.lastname: Cognetta
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate