Publication:

Management of cutaneous head and neck squamous cell carcinoma with trigeminal nerve involvement: a systematic review

Cutaneous head and neck squamous cell carcinoma (cHNSCC) is the second most common cancer worldwide, carrying a favorable prognosis. Perineural invasion/spread dramatically reduces survival outcomes. The trigeminal nerve (CNV) is most commonly affected, providing abundant opportunities for skull base and intracranial cavity invasion. Standard treatment includes surgery and radiotherapy (SRT). We intended to systematically review the literature on cHNSCC with CNV involvement and evaluate the effects of treatment modalities and pattern of CNV invasion/spread on outcomes. We performed a systematic review according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA). Kaplan-Meier curves were utilized to determine the impact of treatment and pattern of invasion/spread on disease-free survival (DFS) and overall survival (OS). Fifty-one studies were identified, generating a sample size of 172 patients with cHNSCC and CNV involvement. The most common treatment modality was SRT (n=90, 52.9%), and all three major CNV branches were affected with similar frequency (V1 33.7%, V2 33.7%, V3 32.6%). Cox proportional hazards regression models revealed significant differences in OS for V1 vs V2 involvement (HR 2.84 95% CI 1.02-7.89), skull base invasion (HR 3.90 95%CI 1.30-11.65), SRT vs RT alone (HR 5.77 95% CI 2.13-15.6), SRT vs other treatment (HR 6.21 95 CI 2.24-17.20). Only SRT and RT had a significant difference in DFS (HR of 3.90, 95%CI 1.30-11.65). In cHNSCC with CNV involvement, treatment modality and the pattern of CNV are crucial for locoregional control and mortality. V1 involvement and definitive RT are associated with significantly lower survival curves.