Assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapy
Abstract Background Cutaneous squamous cell carcinoma (CSCC) has a propensity for perineural spread (PNS) which is associated with poorer treatment outcomes. Immunotherapy is the new standard of care treatment for advanced CSCC resulting in durable responses. PNS is not captured by traditional respo...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Cancer Imaging |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40644-024-00678-8 |
| _version_ | 1827310021493391360 |
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| author | Karda Cavanagh Luke S. McLean Annette M. Lim Anthony Cardin Sidney M. Levy Danny Rischin |
| author_facet | Karda Cavanagh Luke S. McLean Annette M. Lim Anthony Cardin Sidney M. Levy Danny Rischin |
| author_sort | Karda Cavanagh |
| collection | DOAJ |
| description | Abstract Background Cutaneous squamous cell carcinoma (CSCC) has a propensity for perineural spread (PNS) which is associated with poorer treatment outcomes. Immunotherapy is the new standard of care treatment for advanced CSCC resulting in durable responses. PNS is not captured by traditional response assessment criteria used in clinical trials, e.g. RECIST 1.1, and there is limited literature documenting radiological PNS responses to immunotherapy. In this study we assess PNS responses to immunotherapy using a modified grading system. Methods This is an Australian single-center retrospective review of patients with advanced CSCC who were treated with immunotherapy between April 2018 and February 2022 who had evidence of PNS on pre-treatment magnetic-resonance imaging (MRI). The primary outcome was blinded overall radiological response in PNS using graded radiological criteria, post-commencement of immunotherapy. Three defined timepoints (< 5 months, 5–10 months, > 10 months) were reviewed. Secondary outcomes included a correlation between RECIST 1.1 and PNS assessments and the assessment of PNS on fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT). Results Twenty CSCC patients treated with immunotherapy were identified. Median age was 75.7 years and 75% (n = 15) were male. All patients had locoregionally advanced disease and no distant metastases. Median follow-up was 18.5 months (range: 2–59). 70% (n = 14) demonstrated a PNS response by 5 months. Three patients experienced pseudoprogression. One patient had PNS progression by the end of study follow up. RECIST 1.1 and PNS responses were largely concordant at > 10 months (Cohen’s Kappa 0.62). 5/14 cases had features suspicious for PNS on FDG-PET/CT. Conclusions PNS response to immunotherapy can be documented on MRI using graded radiological criteria. High response rates were seen in PNS with the use of immunotherapy in this cohort and these responses were largely concordant with RECIST 1.1 assessments. FDG-PET/CT demonstrated limited sensitivity in the detection of PNS. |
| first_indexed | 2024-04-24T19:53:03Z |
| format | Article |
| id | doaj.art-a53d1392e6e24d3190ce18dea55dfaee |
| institution | Directory Open Access Journal |
| issn | 1470-7330 |
| language | English |
| last_indexed | 2024-04-24T19:53:03Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Cancer Imaging |
| spelling | doaj.art-a53d1392e6e24d3190ce18dea55dfaee2024-03-24T12:32:19ZengBMCCancer Imaging1470-73302024-03-0124111010.1186/s40644-024-00678-8Assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapyKarda Cavanagh0Luke S. McLean1Annette M. Lim2Anthony Cardin3Sidney M. Levy4Danny Rischin5Department of Cancer ImagingDepartment of Medical OncologyDepartment of Medical OncologyDepartment of Cancer ImagingDepartment of Cancer ImagingDepartment of Medical OncologyAbstract Background Cutaneous squamous cell carcinoma (CSCC) has a propensity for perineural spread (PNS) which is associated with poorer treatment outcomes. Immunotherapy is the new standard of care treatment for advanced CSCC resulting in durable responses. PNS is not captured by traditional response assessment criteria used in clinical trials, e.g. RECIST 1.1, and there is limited literature documenting radiological PNS responses to immunotherapy. In this study we assess PNS responses to immunotherapy using a modified grading system. Methods This is an Australian single-center retrospective review of patients with advanced CSCC who were treated with immunotherapy between April 2018 and February 2022 who had evidence of PNS on pre-treatment magnetic-resonance imaging (MRI). The primary outcome was blinded overall radiological response in PNS using graded radiological criteria, post-commencement of immunotherapy. Three defined timepoints (< 5 months, 5–10 months, > 10 months) were reviewed. Secondary outcomes included a correlation between RECIST 1.1 and PNS assessments and the assessment of PNS on fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT). Results Twenty CSCC patients treated with immunotherapy were identified. Median age was 75.7 years and 75% (n = 15) were male. All patients had locoregionally advanced disease and no distant metastases. Median follow-up was 18.5 months (range: 2–59). 70% (n = 14) demonstrated a PNS response by 5 months. Three patients experienced pseudoprogression. One patient had PNS progression by the end of study follow up. RECIST 1.1 and PNS responses were largely concordant at > 10 months (Cohen’s Kappa 0.62). 5/14 cases had features suspicious for PNS on FDG-PET/CT. Conclusions PNS response to immunotherapy can be documented on MRI using graded radiological criteria. High response rates were seen in PNS with the use of immunotherapy in this cohort and these responses were largely concordant with RECIST 1.1 assessments. FDG-PET/CT demonstrated limited sensitivity in the detection of PNS.https://doi.org/10.1186/s40644-024-00678-8Cutaneous squamous cell carcinomaImmunotherapyPerineural spread |
| spellingShingle | Karda Cavanagh Luke S. McLean Annette M. Lim Anthony Cardin Sidney M. Levy Danny Rischin Assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapy Cancer Imaging Cutaneous squamous cell carcinoma Immunotherapy Perineural spread |
| title | Assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapy |
| title_full | Assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapy |
| title_fullStr | Assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapy |
| title_full_unstemmed | Assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapy |
| title_short | Assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapy |
| title_sort | assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapy |
| topic | Cutaneous squamous cell carcinoma Immunotherapy Perineural spread |
| url | https://doi.org/10.1186/s40644-024-00678-8 |
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