title: Skin cancer of the head and neck with gross or microscopic perineural involvement: Patterns of failure.
abstract: Analyze patterns of failure of patients with head-and-neck cutaneous squamous cell carcinoma with perineural involvement: gross cranial nerve involvement (GCNI), microscopic focal perineural invasion (MFPNI), and microscopic extensive perineural invasion (MEPNI), managed with or without radiotherapy (RT).
  
  
  
  Retrospective review: 102 patients with GCNI, MFPNI and MEPNI, observed or treated with RT from 2000 through 2013. The pathology specimens were reviewed for the purpose of the study.
  
  
  
  35 patients had GCNI, all irradiated definitely; 37% failed in-field, and two year disease free survival (DFS) rate was 56%. 19/30 patients (63%) with MEPNI without evidence of GCNI received adjuvant RT to the course of the nerves supplying the involved skin. Recurrence-free survival (RFS) in nerves (94% vs. 25%, P=0.01) and DFS (73% vs. 40%, P=0.05) were significantly higher in the irradiated MEPNI patients compared with the observed. 10/37 (27%) patients with MFPNI were irradiated adjuvantly. MFPNI had low rate of neural and overall failure, without significant benefit to irradiation over observation.
  
  
  
  In patients with GCNI radiotherapy achieves a substantial chance of disease control. Radiotherapy to nerves at risk in MFPNI did not affect outcome, but in MEPNI it achieved less gross perineural recurrences and better DFS, compared with observation.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Eli
authors.initials: E
authors.lastname: Sapir
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Anagha
authors.initials: A
authors.lastname: Tolpadi
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: McHugh
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Samuels
authors.affiliation: Cancer Management and Research Department, Alexandria University, Egypt.
authors.forename: Eman
authors.initials: E
authors.lastname: Elalfy
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Spector
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shuman
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Malloy
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Prince
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.affiliation: Department of Medicine - Medical Oncology Division, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
authors.affiliation: Department of Radiation Oncology and Biostatistics, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Schipper
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States. Electronic address: eisbruch@umich.edu.
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology*; D003391:Cranial Nerves / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: PNI; Perineural involvement; Radiotherapy; Skin cancer