Abstract:
Perineural invasion (PNI) in head and neck cancer (HNC) is a critical factor associated with poor prognosis, increased recurrence, metastasis, and reduced survival rates [1,2]. PNI occurs when cancer cells invade the perineural space surrounding nerves, allowing tumor spread through nerve sheaths, bypassing traditional therapies [3]. More specifically, PNI is when a tumor adjacent to nerves involves at least 33% of the nerves circumference, or when tumor cells reside within any of the nerve sheath's layers [4]. Despite its importance, PNI is frequently underdiagnosed and detected late due to frequent misdiagnosis and/or microscopic recurrence, complicating treatment and diminishing outcomes. Additionally, it is often associated with significant pain and neurological deficits due to nerve damage, severely impacting the patient's quality of life [5]. This highlights the urgent need for an early and accurate diagnostic method to prevent or mitigate PNI and its devastating effects. Current treatment options for PNI in HNC, such as surgery, radiation, and chemotherapy, have limited efficacy due to the unique biological characteristics of perineural cancer cells and the protective environment of nerve sheaths [3]. Radiation therapy is particularly challenging because cranial nerve pathways are difficult to target precisely, and nearby critical structures can make treatment toxic [6]. Surgical interventions are risky due to the complexity of head and neck anatomy and the potential damage to critical nerves [7]. The lack of effective diagnostic tools and precise treatments for PNI exacerbates these challenges. The clinical value proposition for developing a method to detect and prevent PNI in HNC is substantial. By enabling early detection, oncologists can tailor more effective treatment strategies, potentially reducing nerve involvement and preventing further cancer spread. Key stakeholders, including radiation oncologists, HNC surgeons, and patients, would benefit from a method that enhances early detection and improves treatment precision, ultimately leading to better patient outcomes and decrease costs associated with complex surgeries and high radiation doses for the healthcare system. Given these factors, a solution for preventing perineural invasion in HNC patients presents a significant opportunity for innovation, both in clinical impact and market potential.
