ArticleCancer medicine2025
Rethinking Radiation Therapy for Perineural Invasion in Oral Cancer: Does More Coverage Improve Outcomes?
Article in Cancer medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Intraoperative Molecular Imaging Can Detect Large Nerve Perineural Invasion: A Case Report.Head & neck · 2026Article
- Rethinking Radiation Therapy for Perineural Invasion in Oral Cancer: Does More Coverage Improve Outcomes?Cancer medicine · 2025Article
- Perineural invasion as a neuro-immune niche in head and neck cancer: mechanisms of immune evasion and therapeutic implications.Frontiers in immunology · 2025Review
Corrections and comments
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Authors and funding
24 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPerineural invasion (PNI) in oral squamous cell carcinoma (OSCC) is linked to aggressive tumour behaviour and poorer survival outcomes. Adjuvant radiotherapy (RT) is recommended for PNI-positive OSCC, but optimal RT target volume remains uncertain.
methodsThis study retrospectively analysed 103 patients with histopathologically confirmed PNI-positive OSCC treated between January 2017 and December 2023. All patients underwent surgery followed by adjuvant RT, with or without concurrent chemotherapy. Recurrence patterns were categorised as in-field, marginal or out-of-field. Survival outcomes, including overall survival (OS) and disease-free survival (DFS), were assessed using the Kaplan-Meier method, and prognostic factors were analysed using univariate and multivariate models.
resultsThe median follow-up was 22.2 months. The 2-year OS and DFS were 63% (95% CI: 53%-75%) and 57% (95% CI: 48%-68%), respectively. In-field recurrences constituted 70% of local failures, with no recurrences observed at the skull base despite conservative RT volumes. Extensive PNI, large nerve involvement and extratumoral spread were significantly associated with higher recurrence rates and poorer survival. Multivariate analysis identified advanced tumour stage (T3/T4) and extranodal extension (ENE) as independent predictors of worse OS (HR: 2.67, p = 0.016; HR: 2.08, p = 0.045, respectively), while depth of invasion (DoI) > 10 mm significantly impacted DFS (HR: 0.28, p = 0.04 for DoI ≤ 10 mm).
conclusionOur findings suggest that expanding RT volumes to cover entire cranial nerve pathways may not improve outcomes and increase the risk of toxicity. A personalised approach to RT planning, incorporating PNI extent, nerve involvement and other high-risk features, is essential for optimising treatment outcomes in PNI-positive OSCC.
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