Affiliation:
1. Department of Otolaryngology – Head & Neck Surgery University of Washington Seattle Washington USA
2. Department of Radiation Oncology University of Washington Seattle Washington USA
3. Division of Medical Oncology, Department of Medicine University of Washington Seattle Washington USA
4. Puget Sound Health Care System Department of Veterans Affairs Seattle Washington USA
Abstract
AbstractBackgroundPerineural invasion (PNI) in head and neck squamous cell carcinoma (HNSCC) portends poor prognosis. Extent of treatment of nerve pathways with varying degrees of PNI and patterns of failure following elective neural radiotherapy (RT) remain unclear.MethodsRetrospective review of HNSCC patients with high‐risk (clinical/gross, large‐nerve, extensive) or low‐risk (microscopic/focal) PNI who underwent curative‐intent treatment from 2010 to 2021.ResultsForty‐four patients (mean follow‐up 22 months; 59% high‐risk, 41% low‐risk PNI) were included. Recurrence following definitive treatment occurred in 31% high‐risk and 17% low‐risk PNI patients. Among high‐risk patients, 69% underwent surgery with post‐operative RT and 46% underwent elective neural RT. Local control (83% low‐risk vs. 75% high‐risk), disease‐free, and overall survival did not differ between groups.ConclusionsHigh local control rates were achieved in high‐risk PNI patients treated with adjuvant or primary RT, including treatment of both involved and uninvolved, communicating cranial nerves, with few failures in electively treated regions.