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Title: Skin Cancer of the Head and Neck With Perineural Invasion: Defining the Clinical Target Volumes Based on the Pattern of Failure

Purpose: To analyze patterns of failure in patients with head-and-neck cutaneous squamous cell carcinoma (HNCSCC) and clinical/radiologic evidence of perineural invasion (CPNI), in order to define neural clinical target volume (CTV) for treatment planning. Methods and Materials: Patients treated with three-dimensional (3D) conformal or intensity-modulated radiotherapy (IMRT) for HNCSCC with CPNI were included in the study. A retrospective review of the clinical charts, radiotherapy (RT) plans and radiologic studies has been conducted. Results: Eleven consecutive patients with HNCSCCs with CPNI were treated from 2000 through 2007. Most patients underwent multiple surgical procedures and RT courses. The most prevalent failure pattern was along cranial nerves (CNs), and multiple CNs were ultimately involved in the majority of cases. In all cases the involved CNs at recurrence were the main nerves innervating the primary tumor sites, as well as their major communicating nerves. We have found several distinct patterns of disease spread along specific CNs depending on the skin regions harboring the primary tumors, including multiple branches of CN V and VII. These patterns and the pertinent anatomy are detailed in the this article. Conclusions: Predictable disease spread patterns along cranial nerves supplying the primary tumor sites were found in this study. Awarenessmore » of these patterns, as well as knowledge of the relevant cranial nerve anatomy, should be the basis for CTV definition and delineation for RT treatment planning.« less
Authors:
 [1] ;  [2] ;  [1] ; ; ; ; ;  [3] ;  [4]
  1. Department of Radiation Oncology, University of Michigan, Ann Arbor MI (United States)
  2. Department of Radiology, University of Michigan, Ann Arbor MI (United States)
  3. Department of Head and Neck Surgery, University of Michigan, Ann Arbor MI (United States)
  4. Department of Radiation Oncology, University of Michigan, Ann Arbor MI (United States), E-mail: eisbruch@umich.edu
Publication Date:
OSTI Identifier:
21276768
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 74; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2008.06.1943; PII: S0360-3016(08)03049-6; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; FAILURES; HEAD; NECK; NERVES; PATIENTS; PLANNING; RADIOTHERAPY; SKIN; SURGERY