Treatment and Outcome of Advanced External Auditory Canal and Middle Ear Squamous Cell Carcinoma

Abstract

This is a retrospective study to evaluate the outcomes and complications of combined treatment, surgery with or without adjunctive intraoperative radiotherapy, of locally advanced temporal bone squamous cell carcinoma. A series of 17 patients with locally advanced squamous cell carcinoma of the temporal bone were treated between September 2002 and February 2007. Eleven patients had primary tumors, and 6 patients had recurrences. According to the University of Pittsburgh staging system, 5 patients were stage II (T2 N0), 6 patients were stage III (5, T3 N0 and 1, T1 N1), and 6 patients were stage IV (5, T3 N2b and 1, T4 N0). All patients underwent lateral temporal bone resection and pedicle flap reconstruction. Eight patients received intraoperative and postoperative radiotherapies, 4 patients underwent postoperative radiation alone, whereas 5 patients did not receive any adjunctive treatment. Median follow-up was 29.5 months. No major complications were observed. No patients were found to have residual gross tumor. Disease-free survival was 73.3%, and overall survival was 75.6%. Radical external auditory canal and/or middle ear canal resection is of utmost importance to obtain a good surgical outcome. Postoperative radiotherapy is necessary to obtain good local control; no major adverse effects were observed in the intraoperative radiotherapy patients. The incidence of major complication is minimal after pedicle flap reconstruction.

Temporal Bone Verrucous Carcinoma: Outcomes and Treatment Controversy

“…In more typical variants of squamous cell carcinoma of the temporal bone, adjuvant radiation therapy has been advocated in an attempt to increase local control rates [41]. However, studies indicate a high rate of recurrence for advanced lesions despite the use of adjuvant radiotherapy, and the 5-year survival remains poor [42].…”

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.…”

“…Most cohorts have been limited to squamous cell histology, and comprehensive outcomes analyses have been limited. 2,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Further complicating analysis, there is no recognized American Joint Committee on Cancer (AJCC) or Union Internationale Contre le Cancer (UICC) staging system for tumors of the external auditory canal/temporal bone, with multiple systems having been proposed. 3,16,25,26 To date, the most widely used system is the University of Pittsburgh staging system, first described in 1990 by Arriaga and colleagues 25 and modified in 2000 by Moody et al 3 Other than Pittsburgh stage and surgical margin status, no other factors have been consistently demonstrated to be associated with outcome, and multivariable analyses of factors affecting outcome have not been reported.…”

Temporal bone carcinoma: Classical prognostic variables revisited and modern clinico-pathological evidence

“…11,13,16,17 The pathological grading of the tumor was reported as a factor related to worse prognosis only in a limited number of series. 10,18 In part, facial nerve involvement continues to be controversial with a significant negative prognostic role found by most 11,12,15,16,[19][20][21][22] but not all groups. 23 Dura mater infiltration evidence (both radiological and/or pathological) was reported in most of the series 10,11,21,22 as the strongest negative prognostic factor affecting survival.…”