title: Impact of radiographic findings on for prognosis skin cancer with perineural invasion.
abstract: OBJECTIVE
  Update our experience using radiotherapy (RT) for head-and-neck squamous or basal cell carcinoma with clinical perineural invasion (PNI) and correlate radiographic findings with outcomes.
  
  
  METHODS
  We treated 65 patients with cT4N0 head-and-neck skin cancers with clinical PNI from 1965 to 2009 (N0 disease, 59; N1 disease, 6). Treatment included RT alone (N=18), RT with concurrent chemotherapy (N=14), surgery and postoperative RT (N=26), or postoperative RT with concurrent chemotherapy (N=5), and preoperative RT and surgery (N=2). Patients were stratified by imaging-negative disease (N=11), minimal or moderate peripheral disease (N=18), and macroscopic and/or central disease (N=36). Median RT dose was 72.6 Gy (50.4 to 79.2 Gy). Median follow-up overall and for living patients was 5.4 and 11.6 years, respectively.
  
  
  RESULTS
  Five-year outcomes for imaging-negative disease versus minimal/moderate peripheral disease versus macroscopic/central disease were: local control, 81% versus 60% versus 47% (P=0.23); local-regional control, 80% versus 54% versus 47% (P=0.22); neck control, 100% versus 89% versus 93% (P=0.45); and distant metastasis-free survival, 89% versus 100% versus 93% (P=0.57), respectively. Five-year survival rates for imaging-negative disease versus minimal/moderate peripheral disease versus macroscopic/central disease were: overall survival, 82% versus 50% versus 52% (P=0.26), and cause-specific survival, 100% versus 58% versus 65% (P=0.08). Twenty-two (34%) patients had 1 or more severe (grade ≥3) late complications.
  
  
  CONCLUSIONS
  There is a nonsignificant trend towards improved local control for imaging-negative patients and patients with minimal/moderate peripheral disease compared with macroscopic/central disease. Although survival appears better for imaging-negative patients, extent of imaging-positive PNI did not impact overall or cause-specific survival.
authors: *Departments of Radiation Oncology †Radiology, University of Florida College of Medicine, Gainesville, FL ‡Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors: Christopher J
authors: CJ
authors: Balamucki
authors: Reordan
authors: R
authors: DeJesus
authors: Thomas J
authors: TJ
authors: Galloway
authors: Anthony A
authors: AA
authors: Mancuso
authors: Robert J
authors: RJ
authors: Amdur
authors: Christopher G
authors: CG
authors: Morris
authors: Jessica M
authors: JM
authors: Kirwan
authors: William M
authors: WM
authors: Mendenhall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010525:Peripheral Nerves / Q000000981:diagnostic imaging / Q000473:pathology*; D011379:Prognosis; D011879:Radiotherapy Dosage; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D014057:Tomography, X-Ray Computed