The Outcome of Radical Surgery and Postoperative Radiotherapy for Squamous Carcinoma of the Temporal Bone

Moffat, David A.; Wagstaff, Sherryl; Hardy, David G.

doi:10.1097/01.mlg.0000154744.71184.c7

Cited by 129 publications

(144 citation statements)

References 21 publications

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“…It is important to note that other studies have demonstrated anecdotal numbers of long-term survivors with brain invasion from advanced SCC after temporal bone resection. 10 Hence, resection in this situation cannot be uniformly recommended. Rather, a case-by-case evaluation of the patient's palliative goals is necessary.…”

Section: Surgical Factors Affecting Pfs and Osmentioning

confidence: 99%

Nonmelanoma cutaneous cancers involving the skull base: outcomes of aggressive multimodal management

Raza¹,

Ramakrishna²,

Weber

et al. 2015

JNS

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R epResenting the most common human neoplasm, skin cancers occur in the head and neck region in nearly 90% of cases due to sun exposure. Of these, nonmelanoma skin cancers (NMSCs) pose a unique set of challenges. Basal cell carcinoma (BCC) is the most common malignancy in this area, with squamous cell carcinoma (SCC) second in frequency. BCC is characterized by its propensity for local aggressive growth and the capacity to reach large sizes (greater than 2 cm). SCC is the second most common cutaneous malignancy and is differentiated from BCC by its tendency to spread to regional lymph nodes (15% in tumors greater than 2 cm) and for perineural invasion (2%-15%). While considered a histological subtype of BCC, basosquamous carcinoma (BSCC) is abbreviatioNs BCC = basal cell carcinoma; BSCC = basosquamous cell carcinoma; CN = cranial nerve; MDACC = MD Anderson Cancer Center; NMSC = nonmelanoma skin cancer; OS = overall survival; PFS = progression-free survival; SCC = squamous cell carcinoma. obJect A relative paucity of information exists regarding outcomes from craniofacial resection for advanced nonmelanoma skin cancers involving the skull base. In light of advances in surgical technique and adjuvant therapy protocols, the authors reviewed their surgical experience to determine disease control rates, overall survival (OS), morbidity, and mortality. methods A retrospective review of 24 patients with nonmelanoma cutaneous cancers with skull base involvement treated with craniofacial resection at The University of Texas MD Anderson Cancer Center from 1994 to 2012 was performed. Of these patients, 19 (79%) had squamous cell carcinoma (SCC), 4 (17%) had basosquamous carcinoma (BSCC), and 1 patient (4%) had adenocarcinoma. Factors as assessed were prior treatment, TNM staging, tumor involvement, extent of intracranial extension, margin status, postoperative complications, recurrence, disease status at last follow-up, and long-term survival. The majority of tumors were T4 (67%) according to the TNM classification; perineural extension was noted in 58%, cavernous sinus involvement in 25%, and dural involvement in 29%. results Postoperative complications occurred in 4 patients (17%) including 1 death. Kaplan-Meier estimates were calculated for OS and progression-free survival (PFS). Median OS was 43.2 months with an 82% 1-year OS and 37% 5-year OS; the median PFS was 91.2 months. Margin status was positively associated with median OS in SCC (91 months [for negative margins] vs 57 months, p = 0.8) and in BSCC (23.7 vs 3.2 months, p < 0.05). Postoperative radiotherapy was associated with improved median OS (43.2 vs 22 months, p = 0.6). Brain involvement was uniformly fatal after 1 year, while cavernous sinus involvement (31 vs 43 months, p = 0.82), perineural disease (31 vs 54 months, p = 0.30), and T4 stage (22 vs 91.2 months, p = 0.09) were associated with worsened OS. Similar associations were found with median PFS. coNclusioNs Aggressive multimodality management with surgery and postoperative radiotherapy can positively...

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Section: Surgical Factors Affecting Pfs and Osmentioning

confidence: 99%

Nonmelanoma cutaneous cancers involving the skull base: outcomes of aggressive multimodal management

Raza¹,

Ramakrishna²,

Weber

et al. 2015

JNS

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“…Early surgical attempts to remove these tumors usually involved high morbidity and mortality. These mortality rates have substantially decreased from Lewis's 8 series to the more recent series of Moffat et al and Yin et al [7] as a result of advances in surgery and radiotherapy in the last three decades. The overall 5-year survival rates rank between 40 and 70%, but only reach 20% when advanced stages are considered.…”

Section: Discussionmentioning

confidence: 98%

Rare Case of Temporal Bone Carcinoma with Intracranial Extension

Kasim

Abdullah

2011

Indian J Otolaryngol Head Neck Surg

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Temporal bone cancer, a relatively rare disease, accounting for less than 0.2% of all tumors of the head and neck and is associated with a poor outcome; often presents in a subtle manner, which may delay diagnosis. It should be suspected in any case of persistent otitis media or otitis externa that fails to improve with adequate treatment. Despite advances in operative technique and postoperative care, long-term survival remains poor). It includes cancers arising from pinna that spreads to the temporal bone, primary tumors of the external auditory canal (EAC), middle ear, mastoid, petrous apex, and metastatic lesions to the temporal bone. Here is a report on a case of temporal bone carcinoma presenting with right otalgia, otorrhea and facial paralysis. The patient was initially diagnosed as mastoiditis and later the clinical impression was revised to temporal bone carcinoma (undifferentiated type), based on the pathologic findings.

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“…Surgical resection is crucial as a treatment modality, and early surgical intervention is associated with increased survival [2,9,27].…”

Section: Discussionmentioning

confidence: 99%

“…Since then, the management has evolved from piecemeal temporal bone resection to en bloc temporal bone resection and further to combined modality treatment of surgery and post-operative RT [9]. In a retrospective analysis of 21 patients, Kollert et al [29] found that stage-dependent lateral or subtotal TBR (write full for first time) combined with parotidectomy as well as a neck dissection was the most beneficial approach.…”

Section: Discussionmentioning

confidence: 99%

“…Although several treatment modalities have been described in the literature, there is a lack of consensus as to the best treatment, mainly due to the absence of prospective randomized studies [8]. Aggressive surgery, with postoperative radiation therapy (RT) remains the usual treatment so far [9]. In this study, we report a rare case of EAC SCC in a post irradiated female revealed by a hearing loss which makes it an unusual presentation of the disease.…”

Section: Introductionmentioning

confidence: 91%

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Hearing Loss Revealing a Squamous Cell Carcinoma of External Auditory Canal in a Post-Irradiated Patient for Nasopharyngeal Carcinoma

Chafiki¹

2017

MOJBM

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Background: Primary Carcinoma of external auditory canal (EAC) is a rare disease accounting for less than 2% of head and neck cancers and has an annual incidence of around 1 per million populations. EAC carcinoma in postirradiated nasopharyngeal carcinoma (NPC) patients occurs with an incidence of approximately 0.15%. It arises from the external ear and spreads to the temporal bone and surrounding sites. Although its rarity, it is a life threatening disease with practically a poor constant prognosis. Primary EAC carcinoma can occur with no specific symptoms. Aggressive surgery with postoperative radiation remains the usual treatment until now. We report a rare case of a squamous cell carcinoma (SCC) of EAC revealed by a progressive hearing loss as first presentation of the disease in a post-irradiated woman for NPC. Results:A 47-year-old female with a past medical history of nasopharyngeal carcinoma treated with chemo radiation therapy, presented for repeated leftsided purulent ear discharge and progressive hearing loss. Otoscopic examination revealed a tissue mass filling the left EAC. CT scan revealed a soft tissue density process filling the EAC, encroaching upon the tympanic cavity and coming into contact with the handle of the malleus neither with no acicular lyses nor EAC walls erosion. The biopsy of the mass was consistent with EAC SCC. The patient under went lateral temporal bone resection with homolateral superficial parotidectomy and selective neck dissection and completed by an adjuvant external radiation therapy [RT]. Conclusion:Post-irradiation EAC SCC has similar symptoms and invades similar regions as its primary counterpart. This entity is usually discovered in the early stage in post-irradiated EAC SCC patients comparing to the primary EAC SCC. Aggressive surgical treatment is strongly recommended, but adjuvant radiotherapy for early stage EAC SCC should be provided cautiously to prevent further radiation induced complications.

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The Outcome of Radical Surgery and Postoperative Radiotherapy for Squamous Carcinoma of the Temporal Bone

Cited by 129 publications

References 21 publications

Nonmelanoma cutaneous cancers involving the skull base: outcomes of aggressive multimodal management

Nonmelanoma cutaneous cancers involving the skull base: outcomes of aggressive multimodal management

Rare Case of Temporal Bone Carcinoma with Intracranial Extension

Hearing Loss Revealing a Squamous Cell Carcinoma of External Auditory Canal in a Post-Irradiated Patient for Nasopharyngeal Carcinoma

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