Primary definitive radiotherapy with or without chemotherapy for squamous cell carcinoma of the temporal bone

Neoadjuvant Immunotherapy for Head and Neck Squamous Cell Carcinoma: Expecting Its Application in Temporal Bone Squamous Cell Carcinoma

Temporal bone malignant tumors are characterized by atypical clinical symptoms, and easy recurrence and metastasis. They account for 0.2% of head and neck tumors, and the most common pathological type is squamous cell carcinoma. Patients with squamous cell carcinoma of the temporal bone are often at advanced stages when diagnosed, and lose the chance for surgery. Neoadjuvant immunotherapy has recently been approved as the first-line treatment for refractory recurrent/metastatic squamous cell carcinoma of the head and neck. However, it remains to be determined whether neoadjuvant immunotherapy can be used as the first-line treatment for temporal bone squamous cell carcinoma to reduce the tumor stage before surgery, or as a palliative treatment for patients with unresectable advanced stage carcinoma. The present study reviews the development of immunotherapy and its clinical application in head and neck squamous cell carcinoma, summarizes the treatment of temporal bone squamous cell carcinoma, and prospects the neoadjuvant immunotherapy as the first-line treatment for temporal bone squamous cell carcinoma.

Evaluation of subclasses for T4-classified squamous cell carcinoma of the external auditory canal

Background

T4‐classified squamous cell carcinoma (SCC) of external auditory canal (EAC) can potentially involve different anatomical structures, which could translate into different treatment strategies and survival outcomes within one classification. Our aim is to evaluate the clinical added value of T4‐subclasses proposed by Lavieille and by Zanoletti.

Methods

Retrospective data, including patients with primary operated cT4‐classified EAC SCC, was obtained from 12 international hospitals. We subclassified according to the T4‐subclasses. The treatment strategies, disease‐free survival (DFS) and overall survival per subclass were calculated.

Results

A total of 130 T4‐classified EAC SCC were included. We found commonly used treatment strategies per subclass according to Lavieille and the DFS seems also to differ per subclass. Subclass according to Zanoletti showed comparable treatment strategies and survival outcomes per subclass.

Conclusion

Our study suggests that the subclass according Lavieille might have added value in clinical practice to improve care of T4‐classified EAC SCC.

Treatment Strategies for Malignancies of the External Auditory Canal

Malignant tumors of the external auditory canal (EAC) are rare tumors in the head and neck. Delayed diagnosis is not uncommon because the symptoms of early tumors are nonspecific. Various surgical and oncological treatment modalities have been reported. Decision-making depends on pathological feature and stage of the lesions, patient’s general condition and preference, and physician’s experience and skill. Radical surgery is widely accepted as the primary treatment of choice. Postoperative radiotherapy is used more often to improve local and regional control of the disease. Chemotherapy is usually recommended for advanced disease, residual disease, and metastasis. Prognosis is affected by multiple factors such as TNM stage, surgical margin, pathological type and differentiation of tumor, involvement of facial nerve, and so on. Although the survival rate is improved significantly over the past several decades with the development of skull base surgery, neuroradiology, anesthesiology, and oncology, it remains challenging to diagnose and treat EAC malignancies due to the rarity, the local anatomical complexity of temporal bone, and the lack of standard TNM staging system.

Squamous cell carcinoma of the temporal bone: A current review

OBJECTIVES

The rarity of temporal bone squamous cell carcinoma (TBSCC) precludes a clear understanding of the disease and approach to its management. This review provides general background on the disease and discusses the current and emerging oncologic and rehabilitative management options.

DATA SOURCES

PubMed literature review.

METHODS

A review of the current literature was conducted to assess and collate up-to-date information regarding TBSCC management.

RESULTS

TBSCC is a rare and aggressive disease arising in the ear canal, temporal bone, or extratemporal sites. Prior radiation, chronic ear disease, or habitual ear picking may contribute to primary disease development. Because the symptoms of TBSCC and benign otologic disease are similar, TBSCC diagnosis may be delayed, allowing the tumor time to spread throughout the anatomically intricate temporal bone. The extent of the disease is determined based on imaging and is usually staged with the Pittsburgh Staging System. Temporal bone resection with parotidectomy and neck dissection is the current standard of care. Survival is generally good for early disease and poor for advanced disease, but chemotherapy is emerging as a promising treatment option. Auditory rehabilitation with osseointegrated hearing aids is recommended at initial oncologic resection.

CONCLUSIONS

The knowledge of and outcomes for TBSCC have improved with time, but because of the aggressive nature of the disease and the anatomic intricacy of the temporal bone, TBSCC treatment is complex and should be delivered by a multidisciplinary team. Inter-institutional collaboration may accelerate research for this rare disease.

LEVEL OF EVIDENCE

5.