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J Neurol Surg B Skull Base 2016; 77(02): 173-181
DOI: 10.1055/s-0036-1571839
Review Article
Georg Thieme Verlag KG Stuttgart · New York

The Role of Postoperative Radiotherapy for Large Nerve Perineural Spread of Cancer of the Head and Neck

Peter Gorayski
1   Radiation Oncology Centres, Mater Private Hospital Springfield, Springfield, Queensland, Australia
2   School of Medicine, University of Queensland, Brisbane, Queensland, Australia
,
Matthew Foote
2   School of Medicine, University of Queensland, Brisbane, Queensland, Australia
3   Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
,
Sandro Porceddu
2   School of Medicine, University of Queensland, Brisbane, Queensland, Australia
3   Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
,
Michael Poulsen
2   School of Medicine, University of Queensland, Brisbane, Queensland, Australia
4   Radiation Oncology Mater Centre, Brisbane, Queensland, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
26 February 2016 (online)

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Abstract

Large nerve perineural spread (LNPNS) is an uncommon but serious sequelae of cutaneous and salivary gland malignancies arising in the head and neck. This distinct clinical entity is caused by malignant cell spread along the course of larger (named) cranial nerves in a bidirectional pattern of spread toward the origins of the nerve in the brainstem and/or its most distal branches residing in the dermis. Untreated, LNPNS causes multiple cranial neuropathies that significantly impact on quality of life and ultimately is fatal. Curative treatment involves en bloc surgical resection of all known involved sites of gross disease followed by risk-adapted postoperative radiotherapy (PORT) to improve local control. We review the evidence for contemporary practice and outline the processes involved in the delivery of PORT using the zonal anatomical classification.

Keywords

perineural infiltration - radiotherapy - cutaneous - skull base - squamous cell carcinoma - adenoid cystic carcinoma
 

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