Squamous cell carcinoma of temporal bone: Reported on 33 patients

Abstract

Background This study assessed the treatment results of a series of 33 patients with squamous cell carcinoma (SCC) of the temporal bone and evaluated the efficacy of mastoidectomy combined with perioperative radiation therapy protocol. Methods Thirty‐three patients with biopsy‐proven SCC invaded to the temporal bone were reviewed retrospectively and staged into three subgroups according to the University of Pittsburgh TNM Staging System. There were 3 patients with Stage I and II disease(tumor confined to auditory canal), 17 patients with Stage III (tumor involving the middle ear or mastoid), and 13 patients with Stage IV(more extensive disease). Two patients were treated by surgery alone. Eleven patients received irradiation only, and the remaining 20 patients underwent combined surgery and perioperative radiotherapy. The surgical intervention included sleeve resection for patients with Stage I and II lesions and mastoidectomy for all patients with Stage III and IV lesions except 1 who had subtotal temporal bone resection. The radiation dose delivered was in the range of 3500∼10 000 cGy, with an average dose of 6560 cGy. Results The five‐year survival rate for the whole series was 51.7% by the life‐table analysis. After being staged into three subgroups (ie, Stage I + II, Stage III, and Stage IV), the estimated five‐year survival rates were 100%, 68.8%, and 19.6%, respectively (p = 0.04). Radiation alone yielded a 28.7% five‐year survival, while combined surgery and irradiation gave a result of 59.6% (p = 0.80). For patients treated with planned combined therapy, the actuarial five‐year survival rates were 72.7% (8/11) for Stage III disease and 12.5% (1/8) for Stage IV disease (p = 0.02). Twelve patients who died of disease did so of local recurrence (10 cases), cervical metastases (1 case), and liver metastases (1 case), with 70% of succumbing to their diseases within two years. Complications include osteonecrosis (n = 1), osteitis (n = 3), radiation dermatitis (n = 2), facial nerve palsy (n = 2), and delayed healing (n = 2). Data on clinical presentation and treatment modality were also analyzed. Conclusion The results of mastoidectomy with removal of all gross tumor, combined with planned perioperative irradiation therapy, seems to be a useful approach for SCC of the temporal bone. This gives at least as good, and possibly better, five‐year survival than temporal bone resection. The mastoidectomy procedure creates less operative morbidity and mortality. To facilitate the development of more effective means of treating advanced disease, an accepted staging system and cooperative group investigation is necessary. © 1999 John Wiley & Sons, Inc. Head Neck 21: 461–466, 1999.

Predictors of Survival and Recurrence after Temporal Bone Resection for Cancer

“…The extant literature consists of numerous case series that have reported a wide range of survival data, reflecting differences in the underlying characteristics of cohorts drawn from various institutions. 1,6,[8][9][10][12][13][14][15]18,19,22,24,[30][31][32][33][34][35][36][37][38][39][40][41] Historical survival data can be most readily generalized to clinical practice if factors predictive of outcome can be identified. Several larger series have reported preliminary descriptions of factors influencing survival, based on univariate comparisons.…”

“…These numbers are reflections of the underlying characteristics of the patient cohort at each institution. [8][9][10][11][12][13][14][15][17][18][19]22,23,[30][31][32]34,35,[37][38][39][40][41][42] Attempting to improve understanding of prognostic factors, 5 groups have recently analyzed outcomes using univariate analyses. In 1997, Testa et al 20 Based on these outcomes data, we currently consider the minimum operation for the vast majority of malignant disease involving the external auditory canal/temporal bone to be a lateral temporal bone resection.…”

Prognostic factors for squamous cell carcinoma of the temporal bone: extensive bone involvement or extensive soft tissue involvement?

“…Many publications have tried to evaluate survival in this aggressive disease, but patient numbers are limited (ranging from 10 to 39 patients, with most <30 patients), and surveillance periods are too long (ranging from 10 to 37 years, with most >15 years), possibly due to the rarity of this disease. [1][2][3][4][5][6][7][8][9] The quality of imaging studies (Computed tomography (CT) and magnetic resonance imaging (MRI)) has improved dramatically over time, and the accuracy of diagnosis of this disease is influenced by the quality of imaging. Similar reports contain many patients, but they are multi-institutional retrospective studies, with the surgical procedure and the surgeon different at each institution and surveillance periods are too long (>20 years).…”

A network of French experts for the management of rare ENT cancers (REFCOR)

“…Les seules é tudes publié es sont des sé ries ré trospectives ou des case report [14]. Le pronostic dé pend du stade (stades I + II : 100 % de survie à cinq ans, stade III : 73 %, stade IV : 20 % [18]). Les facteurs de risque sont inconnus.…”