TY - JOUR
T1 - Perineural Invasion and Perineural Tumor Spread in Head and Neck Cancer
AU - Bakst, Richard L.
AU - Glastonbury, Christine M.
AU - Parvathaneni, Upendra
AU - Katabi, Nora
AU - Hu, Kenneth S.
AU - Yom, Sue S.
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Perineural invasion (PNI), the neoplastic invasion of nerves, is a common pathologic finding in head and neck cancer that is associated with poor clinical outcomes. PNI is a histologic finding of tumor cell infiltration and is distinct from perineural tumor spread (PNTS), which is macroscopic tumor involvement along a nerve extending from the primary tumor that is by definition more advanced, being radiologically or clinically apparent. Despite widespread acknowledgment of the prognostic significance of PNI and PNTS, the mechanisms underlying its pathogenesis remain largely unknown, and specific therapies targeting nerve invasion are lacking. The use of radiation therapy for PNI and PNTS can improve local control and reduce devastating failures at the skull base. However, the optimal volumes to be delineated with respect to targeting cranial nerve pathways are not well defined, and radiation can carry risks of major toxicity secondary to the location of adjacent critical structures. Here we examine the pathogenesis of these phenomena, analyze the role of radiation in PNI and PNTS, and propose guidelines for radiation treatment design based on the best available evidence and the authors’ collective experience to advance understanding and therapy of this ominous cancer phenotype.
AB - Perineural invasion (PNI), the neoplastic invasion of nerves, is a common pathologic finding in head and neck cancer that is associated with poor clinical outcomes. PNI is a histologic finding of tumor cell infiltration and is distinct from perineural tumor spread (PNTS), which is macroscopic tumor involvement along a nerve extending from the primary tumor that is by definition more advanced, being radiologically or clinically apparent. Despite widespread acknowledgment of the prognostic significance of PNI and PNTS, the mechanisms underlying its pathogenesis remain largely unknown, and specific therapies targeting nerve invasion are lacking. The use of radiation therapy for PNI and PNTS can improve local control and reduce devastating failures at the skull base. However, the optimal volumes to be delineated with respect to targeting cranial nerve pathways are not well defined, and radiation can carry risks of major toxicity secondary to the location of adjacent critical structures. Here we examine the pathogenesis of these phenomena, analyze the role of radiation in PNI and PNTS, and propose guidelines for radiation treatment design based on the best available evidence and the authors’ collective experience to advance understanding and therapy of this ominous cancer phenotype.
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U2 - 10.1016/j.ijrobp.2018.12.009
DO - 10.1016/j.ijrobp.2018.12.009
M3 - Review article
C2 - 30562546
AN - SCOPUS:85062399480
SN - 0360-3016
VL - 103
SP - 1109
EP - 1124
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -