Definitive Radiotherapy for Skin and Adenoid Cystic Carcinoma with Perineural Invasion

Abstract

Adenoid cystic carcinomas (ACC) and, to a lesser extent, cutaneous squamous cell carcinomas and basal cell carcinomas may exhibit perineural invasion (PNI). A subset of patients have tumors with extensive PNI tracking to the skull base that are incompletely resectable and are treated with definitive radiotherapy (RT). RT may be administered with intensity-modulated RT or proton RT. Patients with ACC may also be considered for neutron RT, although the number of available neutron facilities is limited. A substantial proportion of patients with incompletely resectable ACCs and cutaneous carcinomas may be cured with definitive RT. Proton RT provides a more conformal dose distribution compared with other modalities and is likely associated with a lower risk of complications.

Keywords

head and neck - outcomes - radiotherapy - radiation therapy - skin cancer

• References

• 1 Balamucki CJ, Amdur RJ, Werning JW , et al. Adenoid cystic carcinoma of the head and neck. Am J Otolaryngol 2012; 33 (5) 510-518
• 2 Balamucki CJ, Mancuso AA, Amdur RJ , et al. Skin carcinoma of the head and neck with perineural invasion. Am J Otolaryngol 2012; 33 (4) 447-454
• 3 Pommier P, Liebsch NJ, Deschler DG , et al. Proton beam radiation therapy for skull base adenoid cystic carcinoma. Arch Otolaryngol Head Neck Surg 2006; 132 (11) 1242-1249
• 4 Mendenhall WM, Riggs CE, Vaysberg M, Amdur RJ, Werning JW. Altered fractionation and adjuvant chemotherapy for head and neck squamous cell carcinoma. Head Neck 2010; 32 (7) 939-945
• 5 Bhandare N, Monroe AT, Morris CG, Bhatti MT, Mendenhall WM. Does altered fractionation influence the risk of radiation-induced optic neuropathy?. Int J Radiat Oncol Biol Phys 2005; 62 (4) 1070-1077
• 6 Monroe AT, Bhandare N, Morris CG, Mendenhall WM. Preventing radiation retinopathy with hyperfractionation. Int J Radiat Oncol Biol Phys 2005; 61 (3) 856-864
• 7 Douglas JG, Laramore GE, Austin-Seymour M, Koh W, Stelzer K, Griffin TW. Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy. Int J Radiat Oncol Biol Phys 2000; 46 (3) 551-557
• 8 Mendenhall WM, Amdur RJ, Hinerman RW, Cognetta AB, Mendenhall NP. Radiotherapy for cutaneous squamous and basal cell carcinomas of the head and neck. Laryngoscope 2009; 119 (10) 1994-1999
• 9 Kropp L, Balamucki CJ, Morris CG , et al. Mohs resection and postoperative radiotherapy for head and neck cancers with incidental perineural invasion. Am J Otolaryngol 2013; 34 (5) 373-377
• 10 Balamucki CJ, DeJesus R, Galloway TJ , et al. Impact of radiographic findings on for prognosis skin cancer with perineural invasion. Am J Clin Oncol 2015; 38 (3) 248-251
• 11 Mendenhall WM, Ferlito A, Takes RP , et al. Cutaneous head and neck basal and squamous cell carcinomas with perineural invasion. Oral Oncol 2012; 48 (10) 918-922