What is it about?
Peri neural invasion (PNI) confers much poorer prognosis over and above other high risk features like ECE and positive margins in Buccoalveolar carcinomas. Strategies are suggested to improve locoregional control and survival in patients with PNI positive disease
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Why is it important?
PNI is highly predictive for early relapse after multimodality treatment of Buccoalveolar carcinomas. Locally advanced patients of Buccoalveolar carcinoma with PNI +ve disease had much worse survival as compared to PNI -ve disease and it was the only adverse prognostic factor despite aggressive adjuvant Radiation and concurrent chemotherapy. Awareness needs to improve among pathologists to improve its reporting including various criteria of various grades of PNI. Greater awareness is required among Radiation Oncologists to modify the radiation portals which should include antegrade and retrograde neural pathways to reduce locoregional recurrences and help in improving survival.
Perspectives
Quite a few patients of locally advanced Buccoalveolar carcinomas fail loco-regionally despite aggressive Surgery and postoperative radiation and concurrent chemotherapy. ECE and positive margins are traditionally recognized as adverse prognostic factors and despite aggressive adjuvant treatment, locoregional recurrences remain high. In this study PNI was found to be the only adverse prognostic factor in these patients. Hence, it is suggested that radiation treatment needs modification specially to cover neural pathways to try and reduce locoregional recurrences and survival.
Anil Anand
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This page is a summary of: Significance of perineural invasion in locally advanced bucco alveolar complex carcinomas treated with surgery and postoperative radiation ± concurrent chemotherapy, Head & Neck, April 2017, Wiley,
DOI: 10.1002/hed.24792.
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