Abstract
PurposeTo report our experience with the delivery of passively scattered proton therapy in the management of nonmelanoma skin cancers with clinical perineural invasion.Materials and MethodsWe reviewed the medical records of patients who received definitive or postoperative proton therapy for nonmelanoma skin cancer with clinical perineural invasion at our institution and updated patient follow-up when possible. All patients were treated with curative intent with or without the delivery of concurrent systemic therapy. We report disease control rates and the rates of late toxicity among this cohort.ResultsTwenty-six patients treated between 2008 and 2017 were included in the analysis. Following proton therapy, the 3-year overall, cause-specific, and disease-free survival rates were 59%, 73%, and 60%, respectively. The 3-year local control, local regional control, and distant metastasis-free survival rates were 80%, 65%, and 96%, respectively. On univariate analysis, surgical resection before radiation therapy significantly improved local regional control rates at 3 years (55% versus 86%; P = .04). Grade 3+ late toxicities occurred in 13 patients (50%) and the most common toxicities included grade 3+ keratitis of the ipsilateral eye, which occurred in 4 patients (15%) and grade 3+ brain necrosis in 4 patients (15%).ConclusionProton therapy is effective in the management of nonmelanoma skin cancer with clinical perineural invasion. Although disease control and complication rates compare favorably to those previously published for photon-based radiation therapy, the risk for late toxicity is significant and patients should be appropriately counseled.
Highlights
Nonmelanoma skin cancer (NMSC) is the most common cancer in the United States with 5.4 million cases diagnosed per year [1]
The presence of clinical perineural invasion (PNI) is associated with higher rates of local regional recurrence and lower overall survival following radiation therapy when compared to patients without PNI [6]
Proton therapy has a role in the management of patients with NMSC with clinical PNI of the head and neck
Summary
Nonmelanoma skin cancer (NMSC) is the most common cancer in the United States with 5.4 million cases diagnosed per year [1]. An estimated 1% to 5% of patients present with perineural invasion (PNI) defined by an infiltration of tumor cells along local nerves within the head and neck. These tumor cells invade the space between or under the 3 layers enclosing the peripheral nerves near. Nonmelanoma skin cancer with clinical PNI the primary tumor [2,3,4]. The presence of clinical PNI is associated with higher rates of local regional recurrence and lower overall survival following radiation therapy when compared to patients without PNI [6]
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