What is it about?
There are many prognostic factors in oral cancers beyond TNM staging. Peri neural invasion has not so far been recognized as independent risk factor. Our publication shows it to be an independent risk factor. It leads to much worse local control and survival. Suggestions have been discussed to include high risk regions dictated by peri neural spread in the Radiation portals in order to reduce locoregional recurrences and improve survival.
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Why is it important?
It is important to recognize and report peri neural invasion since it has some peculiar way of antegrade and retrograde spread of the tumor which needs to be encompassed in the postoperative radiation portal. With current high technology techniques like IMRT , it is now very much possible to cover these technically difficult areas in the base of skull to reduce locoregional recurrences and survival.
Perspectives
Some of the patients with locally advanced tumors and some with relatively early stage tumors of oral cavity have early local recurrences with rapid downhill course. Out of many risk factors analysed in our study, peri neural invasion (PNI) was found to be an independent prognostic factor which can explain poor outcome in these patients. We suggest to cover antegrade and retrograde pathways of PNI in postoperative Radiation therapy portals, which can contribute to an improved survival in PNI positive patients.
Anil Anand
Read the Original
This page is a summary of: Design Review, January 2008, Elsevier,
DOI: 10.1016/b978-075068309-8.50006-6.
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