title: Perineural invasion in head and neck cancers - a review.
abstract: BACKGROUND
  perineural invasion is an under-recognized way of metastatic spread via tumoral invasion of the nerves. It is encountered in malignancies located in the head and neck but also in cancers involving the pancreas, colon and rectum, prostate, biliary tract and stomach. For some tumors, it may be the only way of metastatic spread. It represents a marker for poor outcome, with increased risk for locoregional recurrence and reduced survival rates. The molecular mechanisms behind this process are not yet fully understood; research is done to identify new therapeutic targets in order to achieve disease control.
  
  
  OBJECTIVE
  to make a rigorous analysis of this phenomenon and to highlight the best therapeutic approach.
  
  
  RESULTS
  a review of the current literature in order to harmonize the international protocols to our local pathology.
  
  
  CONCLUSIONS
  the surgical intervention is decisive to defeat the malignant process but must be associated with modern therapeutic methods, such as the image-guided radiation therapy and immunotherapy.
authors.affiliation: Bucharest Emergency Hospital, Bucharest, Romania ; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Frunza
authors.affiliation: Bucharest Emergency Hospital, Bucharest, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Slavescu
authors.affiliation: Bucharest Emergency Hospital, Bucharest, Romania ; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Lascar
mesh_terms: D006258:Head and Neck Neoplasms / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000503:physiopathology*; D019635:Neurosurgical Procedures / Q000379:methods*; D010525:Peripheral Nerves / Q000503:physiopathology* / Q000601:surgery; D061089:Radiotherapy, Image-Guided / Q000379:methods*
keywords: head and neck cancer; image-guided radiotherapy; perineural invasion; perineural spread