Squamous cell carcinoma of temporal bone: Reported on 33 patients

Background. This study assessed the treatment results of a series of 33 pat ients with squamous cell carcinoma (SCC) of the temporal bone and evaluated the efficacy of mastoidectomy combined with perioperative radiation therap y protocol. Methods. Thirty-three patients with biopsy-proven SCC invaded to the tempor al bone were reviewed retrospectively and staged into three subgroups accor ding to the University of Pittsburgh TNM Staging System. There were 3 patie nts with Stage I and II disease (tumor confined to auditory canal), 17 pati ents with Stage III (tumor involving the middle ear or mastoid), and 13 pat ients 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 les ions except 1 who had subtotal temporal bone resection. The radiation dose delivered was in the range of 3500 similar to 10 000 cGy, with an average d ose 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 res ult 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 di sease 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 di seases within two years. Complications include osteonecrosis (n = 1), ostei tis (n = 3), radiation dermatitis (n = 2), facial nerve palsy (n = 2), and delayed healing (n = 2). Data on clinical presentation and treatment modali ty were also analyzed. Conclusion. The results of mastoidectomy with removal of all gross tumor, c ombined with planned perioperative irradiation therapy, seems to be a usefu l approach for SCC of the temporal bone. This gives at least as good, and p ossibly better, five-year survival than temporal bone resection. The mastoi dectomy procedure creates less operative morbidity and mortality. To facili tate the development of more effective means of treating advanced disease, an accepted staging system and cooperative group investigation is necessary . (C) 1999 John Wiley & Sons, Inc.