TITLE:
Treatment Recommendations among Radiation Oncologists in the Treatment of Cutaneous Squamous Cell Carcinoma with Perineural Invasion
AUTHORS:
Upendra Parvathaneni, Madhu Shetti, Daniel Berg, Seesha Takagishi, George E. Laramore, Chrysalyne D. Schmults, Anokhi Jambusaria-Pahlajani, Stephen D. Hess, Marvin Heyboer III, Jay J. Liao
KEYWORDS:
Cutaneous Squamous Cell Carcinoma, Perineural Invasion, Head and Neck, Post Operative Radiation Therapy
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.11,
October
31,
2016
ABSTRACT: Purpose:
Post-operative radiotherapy (PORT) for resected cutaneous squamous cell carcinoma (CSCC) with perineural invasion (PNI) is
controversial. Therefore, we conducted a survey to review treatment
recommendations among Radiation Oncologists (ROs) in the management of CSCC
with PNI. Materials & Methods: In March 2011, we contacted all ROs and
trainees in the US through email addresses listed in the 2009 ASTRO directory. Our web-based survey presented clinical
vignettes involving Mohs
micrographically resected CSCC with microscopic PNI (mPNI) or clinical
PNI (cPNI). For each vignette, ROs were asked to indicate if PORT was
appropriate and to further specify the dose and volume to treat. Results: Three
hundred fifty two responses were completed and analyzed. The majority of ROs
(72%) had over 10 years of post residency experience. 64% of the sampled ROs
had a special interest in treating head and neck cancers, and 64% treated 4 or
more cases per year. Approximately 95%
recommended PORT for cPNI whereas 59% recommended PORT for mPNI. Post
residency experience (10+ yrs vs. = 0.005) and
for mPNI of deep subcutaneous non-named nerve involvement (80% vs. 60%, p = 0.001). ROs
treating 8 or more cases per year (vs. = 0.01).
Conclusions: Our study demonstrates significant variability among ROs in the
management of CSCC with mPNI. For cases of cPNI, an overwhelming majority
recommended PORT. In cases of mPNI, there was no consensus for recommending
PORT, although experienced practitioners had
a lower threshold for offering treatment. These results indicate the
need for prospective clinical studies to clarify the role of PORT in CSCC
patients with mPNI.