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Sioufi K, Haynes AD, Gidley PW, Maniakas A, Roberts D, Nader ME. Survival Outcomes of Temporal Bone Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2024; 171:1-10. [PMID: 38341629 DOI: 10.1002/ohn.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Temporal bone squamous cell carcinoma (TBSCC) is a rare malignancy with poor prognosis, and optimal treatment for advanced cases is uncertain. Our systematic literature review aimed to assess 5-year survival outcomes for advanced TBSCC across different treatment modalities. DATA SOURCES EMBASE, Medline, PubMed, and Web of Science. REVIEW METHODS A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for articles published between January 1989 and June 2023. RESULTS The review yielded 1229 citations of which 31 provided 5-year survival data for TBSCC. The final analysis included 1289 patients. T classification data was available for 1269 patients and overall stage for 1033 patients. Data for 5-year overall survival (OS) was 59.6%. Five-year OS was 81.9% for T1/2 and 47.5% for T3/4 (P < .0001). OS for T1/T2 cancers did not significantly differ between surgery and radiation (100% vs 81.3%, P = .103). For advanced-stage disease (T3/T4), there was no statistical difference in OS when comparing surgery with postoperative chemoradiotherapy (CRT) (OS 50.0%) versus surgery with postoperative radiotherapy (XRT) (OS 53.3%) versus definitive CRT (OS 58.1%, P = .767-1.000). There was not enough data to assess the role of neoadjuvant CRT. CONCLUSION Most patients will present with advanced-stage disease, and nodal metastasis is seen in nearly 22% of patients. This study confirms the prognostic correlation of the current T classification system. Our results suggest that OS did not differ significantly between surgery and XRT for early stage disease, and combined treatment modalities yield similar 5-year OS for advanced cancers.
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Affiliation(s)
- Krystelle Sioufi
- Department of Family Medicine, University of Montreal, Montreal, Canada
| | - Aaron David Haynes
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anastasios Maniakas
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dianna Roberts
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Brenet E, Atallah S, Guerlain J, Moya-Plana A, Verillaud B, Kania R, Bakhos D, Philouze P, Righini CA, Bozorg A, Mérol JC, Labrousse M, Vergez S, Fakhry N, Gallet P, Cullié D, Malard O, Mauvais O, Fath L, Schultz P, Dufour X, Saroul N, Evrard D, Lesnik M, Even C, Costes V, Thariat J, Taillandier de Gabory LL, Makeieff M, Dubernard X, Baujat B. Carcinomas of the external auditory canal: Management and results: A multicenter REFCOR propensity score matching study. Eur J Cancer 2024; 201:113922. [PMID: 38364629 DOI: 10.1016/j.ejca.2024.113922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To analyse prognostic factors and survival outcomes of malignant tumors of the external auditory canal, to investigate the role of regional surgery, and adjuvant radiotherapy in early stages and to investigate the role of surgery in operable T4 stage. SETTING A retrospective analysis was conducted on all patients prospectively included in the national database of the French Expertize Network for Rare ENT Cancers (REFCOR) from January 2000 to December 2016. PARTICIPANTS 103 patients from 19 reference centers were included. A propensity score matching analysis was applied to enable comparisons between treatments. MAIN OUTCOMES AND MEASURES Event-free survival, overall survival and factors of poor prognosis of the cohort were described. The interest of local and regional surgery and postoperative radiotherapy were evaluated. RESULTS The factors of poor prognosis on event-free survival were immunosuppression (p = 0.002), Karnofsky status less than 90% (p = 0.02), body mass index less than 19 Kg / m2 (p = 0.0009), peripheric facial palsy (p = 0.0016), and positive margin (p = 0.0006). In early stages, locoregional surgery was associated with an increase in event-free survival (p = 0.003, HR = 0.21) versus local surgery alone, while postoperative radiotherapy was not associated with an increase in event-free survival (p = 0.86, HR = 0.91) or overall (p = 0.86, HR = 0.91). In locally advanced stages, locoregional surgery followed by radiotherapy was associated with an increase in event-free survival (p = 0.03, HR = 0.39) and overall (p = 0.02, HR = 0.34) versus chemoradiotherapy alone. CONCLUSION AND RELEVANCE Regional surgery is recommended for early stages of cancers of the external auditory canal. In operable cases, locoregional surgery followed by radiotherapy is recommended.
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Affiliation(s)
- Esteban Brenet
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Sarah Atallah
- Department of ENT-Head and Neck Surgery, Tenon University Hospital, APHP, Sorbonne Universite, 75020 Paris, France; Doctoral School of Public Health, CESP, University of Paris Sud, 94807 Villejuif, France
| | - Joanne Guerlain
- Department of ENT-Head and Neck Surgery, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Antoine Moya-Plana
- Department of ENT-Head and Neck Surgery, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Benjamin Verillaud
- Department of ENT-Head and Neck Surgery, Lariboisière University Hospital, APHP, 75010 Paris, France
| | - Romain Kania
- Department of ENT-Head and Neck Surgery, Lariboisière University Hospital, APHP, 75010 Paris, France
| | - David Bakhos
- Department of ENT-Head and Neck Surgery, Bretonneau University Hospital, 37000 Tours, France
| | - Pierre Philouze
- Department of ENT-Head and Neck Surgery, La Croix Rousse University Hospital, HCL, 6900 Lyon, France
| | - Christian-Adrien Righini
- Department of ENT-Head and Neck Surgery, Grenoble Alpes University Hospital, 38043 Grenoble, France
| | - Alexis Bozorg
- Department of ENT-Head and Neck Surgery, François Mitterrand University Hospital, 21000 Dijon, France
| | - Jean-Claude Mérol
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Marc Labrousse
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Sébastien Vergez
- Department of ENT-Head and Neck Surgery, University Cancer Institute, 31100 Toulouse, France
| | - Nicolas Fakhry
- Department of ENT-Head and Neck Surgery, University Hospital of Marseille, APHM, 13915 Marseille, France
| | - Patrice Gallet
- Department of ENT-Head and Neck Surgery, University Hospital of Nancy, 54000 Nancy, France
| | - Dorian Cullié
- Department of ENT-Head and Neck Surgery, Lacassagne Cancer Institute, 06100 Nice, France
| | - Olivier Malard
- Department of ENT-Head and Neck Surgery, University Hospital of Nantes, 44093 Nantes, France
| | - Olivier Mauvais
- Department of ENT-Head and Neck Surgery, University Hospital of Besançon, 25000 Besançon, France
| | - Léa Fath
- Department of ENT-Head and Neck Surgery, University Hospital of Hautepierre, HUS, 67200 Strasbourg, France
| | - Philippe Schultz
- Department of ENT-Head and Neck Surgery, University Hospital of Hautepierre, HUS, 67200 Strasbourg, France
| | - Xavier Dufour
- Department of ENT-Head and Neck Surgery, University Hospital of Poitiers, 86021 Poitiers, France
| | - Nicolas Saroul
- Department of ENT-Head and Neck Surgery, University Hospital of Clermont-Ferrand, 63000, France
| | - Diane Evrard
- Department of ENT-Head and Neck Surgery, Bichat University Hospital, APHP, 75018 Paris, France
| | - Maria Lesnik
- Department of ENT-Head and Neck Surgery, Curie Cancer Institute, APHP, 75005 Paris, France
| | - Caroline Even
- Department of Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Valérie Costes
- Department of Pathologic Anatomy and onco-biology, University Hospital of Montpellier, France
| | - Juliette Thariat
- Department of Radiation Oncology, Cancer center Baclesse, 14076 Caen, France
| | | | - Marc Makeieff
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Xavier Dubernard
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Bertrand Baujat
- Department of ENT-Head and Neck Surgery, Tenon University Hospital, APHP, Sorbonne Universite, 75020 Paris, France.
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Jang IJH, Thong JF, Teo CEH, Sommat K. Analysis of Prognostic Factors For External Auditory Canal Carcinoma: A 22-Year Experience. Laryngoscope 2023; 133:2203-2210. [PMID: 36478582 DOI: 10.1002/lary.30504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/07/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to investigate the prognostic factors and treatment outcomes in patients with the external auditory canal (EAC) squamous cell carcinoma (SCC). METHODS All patients diagnosed with EAC SCC and treated with curative intent at a single tertiary institution were retrospectively reviewed over a 22-year period. Treatment modalities included surgery with adjuvant treatment or definitive radiotherapy. The primary endpoints were overall survival (OS) and disease-specific survival (DSS). RESULTS There were 51 patients in our cohort. The 5-year OS and DSS were 64.0% ± 7.0% and 72.0% ± 7.0% respectively. Patients in the surgical arm and RT arm showed no significant difference in OS, DSS, and LRFS (p = 0.075, 0.062, 0.058 respectively). Compared to other routes of spread within the temporal bone, pattern of posterior disease invasion (involving mastoid/sigmoid sinus) showed poorer OS and DSS on multivariate analysis (hazard ratio, HR4.34 and 5.88; p = 0.006 and 0.009). On multivariate analysis, the following factors were independently prognostic of poorer OS and DSS: Previous radiotherapy (HR 3.29 and 4.81, p = 0.021 and p = 0.029); Presence of facial nerve palsy (HR 3.80 and 7.63, p = 0.013 and p = 0.003); Posterior pattern of invasion (HR4.05 and 3.59, p = 0.013 and p = 0.043). Advanced modified Pittsburgh stage was not predictive of poor OS and DSS (HR1.17 and 1.17 E+5, p = 0.786 and p = 0.961). CONCLUSION Presence of previous radiotherapy, facial nerve palsy and posterior pattern of disease invasion were independent prognostic factors of poorer survival in patients with EAC SCC. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2203-2210, 2023.
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Affiliation(s)
- Isabelle J H Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jiun Fong Thong
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Constance E H Teo
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kiattisa Sommat
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Lee YJ, Jeong IS, Chung JW. Treatment outcomes of the external auditory canal and temporal bone malignancy with dura invasion. Laryngoscope Investig Otolaryngol 2023; 8:1021-1028. [PMID: 37621272 PMCID: PMC10446266 DOI: 10.1002/lio2.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives This study aimed to evaluate the characteristics and surgical outcomes of patients with external auditory canal (EAC) and temporal bone (TB) malignancy with dura invasion. Methods The medical records of patients with EAC and TB malignancy with dura invasion were retrospectively reviewed. Survival outcomes (overall survival [OS], disease-specific survival [DSS], recurrence-free survival [RFS], and distant metastasis-free survival [DMFS]) were analyzed using the Kaplan-Meier method. Results A total of eight patients were included in this study. The median age at diagnosis was 49.5 years (range 12-74 years). The median follow-up periods were 46.5 months. Histologically, four out of eight patients were diagnosed with squamous cell carcinoma (SCC; 50%). The 2-year OS and DSS rates of all patients were 62.5%, and those of EAC SCC patients were 50% and 66.7%, respectively; while the 2-year RFS and DMFS rates of all patients were 37.5%. There was one local recurrence at the resection site (12.5%), two regional neck nodal recurrences (25%), and two distant metastases (25%). Dura resection and duroplasty areas were not involved in the local recurrence case. Conclusion In EAC and TB cancer with dura invasion, radical surgery with dura resection may show similar survival outcomes to previous studies without recurrence at the dura resection site.Level of evidence: IV.
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Affiliation(s)
- Yun Ji Lee
- Department of Otorhinolaryngology‐Head and Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - In Seong Jeong
- Department of Otorhinolaryngology‐Head and Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology‐Head and Neck Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
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García-Marín R, Cabal VN, Fernández-Cedrón Bermejo C, Riobello C, Suárez-Fernández L, Codina-Martínez H, Navarro-García A, Lorenzo-Guerra SL, García-Martínez J, Vivanco B, López F, Llorente JL, Hermsen MA. A Novel External Auditory Canal Squamous Cell Carcinoma Cell Line Sensitive to CDK4/6 Inhibition. Otolaryngol Head Neck Surg 2023; 168:729-737. [PMID: 35349366 DOI: 10.1177/01945998221089186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize cell line CAE606 derived from a squamous cell carcinoma (SCC) of the external auditory canal (EAC) and to show its usefulness as a model for testing candidate therapeutic agents. STUDY DESIGN Preclinical translational research. SETTING Biomedical research institute. METHODS The cell line was initiated from a moderately differentiated T2N0M0 EAC SCC. We studied its histologic and genetic features as well as growth and invasion parameters. Sensitivity to cell CDK4/6 cell cycle inhibitor palbociclib was analyzed. RESULTS CAE606 cells expressed heavy molecular weight cytokeratin, p63, and vimentin. The population doubling time was 25.8 hours, and the cells showed fast collective cell migration in a wound-healing assay. Short tandem repeat analysis confirmed it to be derived from the primary tumor of the patient. Next-generation sequencing revealed alterations in cell cycle regulation genes, including inactivating mutations in CDKN2A and TP53 and high-level amplification of CCND1 and EGFR. CAE606 showed a strong decrease of phospo-Rb expression upon exposure to the CDK4/6 inhibitor palbociclib, causing significant growth inhibition with an IC50 of 0.46 µM. CONCLUSION This is the first report of a stable EAC SCC cell line. Its genetic features make it a useful tool for preclinical testing of new therapeutic agents for EAC SCC, particularly those targeting cell cycle regulation in combination with radio- and chemotherapy or other specific signaling pathway inhibitors.
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Affiliation(s)
- Rocío García-Marín
- Department of Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Virginia N Cabal
- Department of Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - Cristina Riobello
- Department of Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Laura Suárez-Fernández
- Department of Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Helena Codina-Martínez
- Department of Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Ainhoa Navarro-García
- Department of Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Sara Lucila Lorenzo-Guerra
- Department of Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Jorge García-Martínez
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Blanca Vivanco
- Department of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José Luis Llorente
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Mario A Hermsen
- Department of Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
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McCracken M, Pai K, Cabrera CI, Johnson BR, Tamaki A, Gidley PW, Manzoor NF. Temporal Bone Resection for Squamous Cell Carcinoma of the Lateral Skull Base: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 168:154-164. [PMID: 35290141 DOI: 10.1177/01945998221084912] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/11/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Temporal bone squamous cell carcinoma (TBSCC) is rare and often confers a poor prognosis. The aim of this study was to synthesize survival and recurrence outcomes data reported in the literature for patients who underwent temporal bone resection (TBR) for curative management of TBSCC. We considered TBSCC listed as originating from multiple subsites, including the external ear, parotid, and external auditory canal (EAC), or nonspecifically from the temporal bone. DATA SOURCES PubMed, Cochrane Library, Embase, and manual search of bibliographies. REVIEW METHOD A systematic literature review conducted in December 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Survival data were collected from 51 retrospective studies, resulting in a pooled cohort of 501 patients with TBSCC. Compared to patients undergoing lateral TBR (LTBR), patients undergoing subtotal (SBTR) or total (TTBR) TBR exhibited significantly higher rates of stage IV disease (P < .001), positive surgical margins (P < .001), facial nerve involvement (P < .001), and recurrent disease (P < .001). A meta-analysis of 15 studies revealed a statistically significant 97% increase in mortality in patients who underwent STBR or TTBR. On multivariate analysis, recurrent disease was independently associated with worse overall survival (P < .001). On univariate analysis, facial nerve involvement was also associated with decreased overall survival (P < .001). CONCLUSION Recurrent disease was associated with risk of death in patients undergoing TBR. Larger prospective multi-institutional studies are needed to ascertain prognostic factors for a wider array of postoperative outcomes, including histology-specific survival and recurrence outcomes.
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Affiliation(s)
- Matthew McCracken
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Kavya Pai
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin R Johnson
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Paul W Gidley
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Nauman F Manzoor
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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肖 龙, 刘 爱, 马 华, 江 红. [Current status of the diagnosis and treatment of temporal bone squamous cell carcinoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:559-565. [PMID: 35822388 PMCID: PMC10128389 DOI: 10.13201/j.issn.2096-7993.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Indexed: 06/15/2023]
Abstract
Temporal bone squamous cell carcinoma, which is rare in the clinical setting, is the most common type of temporal bone malignancy. Its rarity makes the staging, the way of temporal bone resection, the management of parotid gland and cervical lymph node, and the application of radiotherapy and chemotherapy still controversial.There is no unanimous consensus and guideline about it to date at home and abroad.This paper reviewed the recent advance in the diagnosis and treatment of temporal bone squamous cell carcinoma in the hope of providing some help and reference for the management of the disease.
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Affiliation(s)
- 龙开 肖
- 南昌大学第一附属医院耳鼻咽喉头颈外科(南昌,330006)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - 爱国 刘
- 华中科技大学同济医学院附属同济医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Huazhong University of Science and Technology
| | - 华良 马
- 华中科技大学同济医学院附属同济医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Huazhong University of Science and Technology
| | - 红群 江
- 南昌大学第一附属医院耳鼻咽喉头颈外科(南昌,330006)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
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8
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Basura GJ, Smith JD, Ellsperman S, Bhangale A, Brenner JC. Targeted molecular characterization of external auditory canal squamous cell carcinomas. Laryngoscope Investig Otolaryngol 2021; 6:1151-1157. [PMID: 34667860 PMCID: PMC8513438 DOI: 10.1002/lio2.654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
HYPOTHESIS Squamous cell carcinomas (SCC) of the external auditory canal (EAC) may harbor unique genomic alterations that may explain aggressive behavior and differentiate these tumors from cutaneous SCCs of other subsites. BACKGROUND EAC SCCs arise in a non-ultraviolet-exposed region of the head and neck, are often locally aggressive and may metastasize to lymph nodes or distant sites. The genomic alterations underlying cutaneous SCC of other sites are well-documented; however, mutational profiles of EAC SCC are less well characterized and may contribute to the unique anatomic site, high rates of recurrence and tumor spread. We performed targeted sequencing of a cohort of primary EAC SCCs to identify recurring and potentially targetable genomic alterations. METHODS Genomic DNA was extracted from formalin-fixed paraffin-embedded specimens of 7 EAC SCCs and subjected to targeted DNA sequencing using a 227-gene panel. Somatic alterations and gene copy number alterations were annotated using our validated, in-house bioinformatics pipelines. RESULTS In our EAC SCCs, we found recurrent alterations in TP53 and genes of receptor tyrosine kinase (eg, EGFR, FGFR) and PI3K pathways (eg, PIK3CA), similar to cutaneous SCCs of other head and neck sites. We also observed a high frequency of telomerase reverse transcriptase amplification and DNA methyltransferase 1 alterations, both of which are rarely observed in cutaneous SCCs of other sites. CONCLUSION These data represent the first step toward precise molecular characterization of EAC SCCs that may lead to an enhanced understanding of tumor biology and modernized precision medicine approaches for unique tumors.Level of Evidence: NA.
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Affiliation(s)
- Gregory J. Basura
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Joshua D. Smith
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan Ellsperman
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Apurva Bhangale
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - John Chad Brenner
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of PharmacologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Qiu K, Pang W, Qiu J, Li J, Cheng D, Rao Y, Dong Y, Mao M, Liu Q, Mu X, Zhang W, Xu W, Ren J, Zhao Y. Evaluating the prognostic contributions of TNM classifications and building novel staging schemes for middle ear squamous cell carcinoma. Cancer Med 2021; 10:7958-7967. [PMID: 34559476 PMCID: PMC8607269 DOI: 10.1002/cam4.4306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/29/2021] [Accepted: 09/05/2021] [Indexed: 02/05/2023] Open
Abstract
Background A universally acknowledged cancer staging system considering all aspects of the T‐, N‐, and M‐classifications for middle ear squamous cell carcinoma (MESCC) remains absent, limiting the clinical management of MESCC patients. Materials and Methods A total of 214 MESCC patients were extracted from the SEER (the Surveillance, Epidemiology, and End Results) database between 1973 and 2016. The relationships between patient’s characteristics and prognoses were analyzed by Kaplan–Meier and Cox proportional hazards regression models. Novel staging schemes for MESCC were designed by adjusted hazard ratio (AHR) modeling method according to the combinations of Stell’s T‐classification and the eighth AJCC N‐ and M‐classifications, of which performances were evaluated based on five criteria: hazard consistency, hazard discrimination, explained variation, likelihood difference, and balance. Results T‐classification was the most significant prognostic factor for MESCC patients in multivariable analysis (p = 0.021). The N‐ and M‐classifications also had obvious prognostic effect but were not statistically significant by multivariate analysis due to the limited metastasis events. Three novel staging schemes (AHR‐Ⅰ–Ⅲ models, different combination of T‐ and N‐classifications) and ST (solely derived from Stell’s T‐classification) were developed, among which the AHR‐Ⅰ staging scheme performed best. Conclusions Tumor extension, quantified by Stell’s T‐classification, is the most significant prognostic factor for MESCC patients. However, our AHR‐Ⅰ staging scheme, a comprehensive staging scheme that integrating T‐, N‐, and M‐classifications, might be an optimal option for clinical practitioners to predict MESCC patients’ prognosis and make proper clinical decisions.
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Affiliation(s)
- Ke Qiu
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Wendu Pang
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianqing Qiu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Junhong Li
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Danni Cheng
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Yufang Rao
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Yijun Dong
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Minzi Mao
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiurui Liu
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaosong Mu
- Department of Oto-Rhino-Laryngology, Langzhong People's Hospital, Langzhong, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Jianjun Ren
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, West China Hospital, Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.,Medical Big Data Center, Sichuan University, Chengdu, China
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10
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Makita K, Hamamoto Y, Takata N, Ishikawa H, Tsuruoka S, Uwatsu K, Hato N, Kido T. Prognostic significance of inflammatory response markers for locally advanced squamous cell carcinoma of the external auditory canal and middle ear. JOURNAL OF RADIATION RESEARCH 2021; 62:662-668. [PMID: 34115873 PMCID: PMC8273788 DOI: 10.1093/jrr/rrab048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/17/2021] [Indexed: 06/12/2023]
Abstract
We investigated the prognostic significance and treatment outcomes of pretreatment inflammatory response markers for locally advanced squamous cell carcinoma (SCC) of the external auditory canal (EAC) and middle ear (ME). Between July 2003 and July 2019, 21 patients with SCC of the EAC (n = 18) or ME (n = 3) who received radiotherapy with or without surgery or systemic therapy (radiotherapy alone [n = 2], radiotherapy + systemic therapy [n = 6], radiotherapy + surgery [n = 7], radiotherapy + surgery + systemic therapy [n = 6]) were retrospectively examined. The median radiation dose was 66.0 (range, 50.4-70.0) Gy, with daily fractions of 1.8-2.0 Gy. The median follow-up period was 25 months (range, 6-137). The two-year overall survival (OS), progression-free survival (PFS), and locoregional control (LC) rates were 61%, 48%, and 55%, respectively. OS, PFS, and LC did not differ significantly according to patient- (age, sex), tumor- (Pittsburgh stage, pretreatment neurological findings), and treatment-related (surgery or systemic therapy, radiation dose, prophylactic neck irradiation) factors. Conversely, there were significant differences in OS, PFS, and LC between patients with high and low pretreatment C-reactive protein-to-albumin ratios (p = 0.002, 0.003, and 0.004, respectively). OS also differed significantly between patients with high and low pretreatment neutrophil-to-lymphocyte ratios (NLR; p = 0.037). Other inflammatory response markers, including platelet-to-lymphocyte ratio (PLR) and albumin-to-globulin ratio (AGR), did not influence OS, PFS, or LC. Our findings suggest that pretreatment C-reactive protein-to-albumin ratio and NLRs have a significant impact on treatment outcomes in patients with locally advanced SCC of the EAC and ME.
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Affiliation(s)
- Kenji Makita
- Corresponding author. Kenji Makita, Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan, FAX: (+81)-89-960-5375, TEL: (+81)-89-960-5371, Mail address:
| | - Yasushi Hamamoto
- Departments of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minami-Umenomoto-Machi, Matsuyama, Ehime 791-0280, Japan
| | - Noriko Takata
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Hirofumi Ishikawa
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Shintaro Tsuruoka
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Kotaro Uwatsu
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Naohito Hato
- Department of Otorhinolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
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11
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Shiga K, Nibu KI, Fujimoto Y, Asakage T, Homma A, Mitani H, Ogawa T, Okami K, Murono S, Hirano S, Ueda T, Hanai N, Tsukahara K, Ota I, Yoshimoto S, Shinozaki T, Iwae S, Katagiri K, Saito D, Kiyota N, Tahara M, Takahashi F, Hayashi R. Sites of invasion of cancer of the external auditory canal predicting oncologic outcomes. Head Neck 2021; 43:3097-3105. [PMID: 34240528 DOI: 10.1002/hed.26800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/27/2021] [Accepted: 06/28/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study aimed to reveal the influence of the invasion site of external auditory canal (EAC) cancer by analyzing the outcome of patients with advanced tumor. METHODS A total of 111 patients with T4 EAC cancer were enrolled in this study. Of these patients, 79 underwent chemoradiotherapy and 32 underwent surgery under curative intent. Univariate and multivariate analyses and the Kaplan-Meier method were used to focus on the tumor invasion sites and overall survival of the patients. RESULTS The 3-year overall survival rate of all patients was 55.0%. In multivariate analysis, the only significant invasion site for overall survival was the facial nerve, with the dura mater being the next most influential site. When Kaplan-Meier survival curve was calculated, facial nerve and dura mater were the significant factors resulting in poor patient outcomes. CONCLUSION The facial nerve and dura mater are crucial sites of EAC cancer for patient outcomes.
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Affiliation(s)
- Kiyoto Shiga
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akihiro Homma
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Mitani
- Department of Head and Neck Surgery, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Takenori Ogawa
- Department of Otolaryngology - Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan
| | - Kenji Okami
- Department of Otolaryngology, Tokai University School of Medicine, Isehara, Japan
| | - Shigeyuki Murono
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Shigeru Hirano
- Department of Otolaryngology - Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsutomu Ueda
- Department of Otorhinolaryngology - Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology - Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ichiro Ota
- Department of Otolaryngology - Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shigemichi Iwae
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Katsunori Katagiri
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Daisuke Saito
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Naomi Kiyota
- Department of Medical Oncology/Hematology, Kobe University Hospital Cancer Center, Kobe, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Fumiaki Takahashi
- Division of Medical Engineering, Department of Information Science, Iwate Medical University, Yahaba, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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12
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Iwami K, Fujii M, Nishio N, Maruo T, Yoshida T, Mukoyama N, Osuka K, Takanari K, Murotani K, Kamei Y, Sone M, Fujimoto Y, Saito K. Surgical Classification of Radical Temporal Bone Resection and Transcranial Tympanotomy: A Retrospective Study from the Neurosurgical Perspective. World Neurosurg 2021; 151:e192-e207. [PMID: 33862297 DOI: 10.1016/j.wneu.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To review the authors' surgical experience with radical temporal bone resection (TBR) with an emphasis on the classification of skull base osteotomy and transcranial tympanotomy (TCT) that is required for middle ear transection. METHODS We reviewed the records of 25 patients who underwent radical TBR at our facilities between 2011 and 2020. RESULTS The osteotomy line of radical TBR was divided into 3 segments: anterior (A), medial (M), and posterior (P). Each segment was further classified as follows: A1, through the glenoid fossa (1 patient); A2, in front of the glenoid fossa (23 patients); A3, through the greater wing of the sphenoid bone (1 patient); M1, through the middle ear (16 patients); M2, through the inner ear (9 patients); P1, through the mastoid (9 patients); and P2, through the posterior cranial fossa (16 patients). The M segment was significantly associated with operation time and intraoperative blood loss. In all patients with M1 osteotomy, TCT was performed; TCT was classified into superior and far posterior approaches. A superior approach was performed in all 16 patients, whereas the far posterior approach was performed in only 7 patients with both M1 and P2 osteotomy. CONCLUSIONS Our newly proposed osteotomy classification of radical TBR is suitable for minute but clinically important adjustment of the osteotomy line. TCT is an indispensable technique for M1 osteotomy; our newly proposed classification expands our understanding of TCT and how to incorporate this technique into radical TBR.
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Affiliation(s)
- Kenichiro Iwami
- Department of Neurosurgery, Aichi Medical University, Aichi, Japan.
| | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Osuka
- Department of Neurosurgery, Aichi Medical University, Aichi, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Aichi Medical University, Aichi, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
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13
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Kline NL, Bhatnagar K, Eisenman DJ, Taylor RJ. Survival outcomes of lateral skull base tumors following temporal bone resection. Head Neck 2021; 43:2414-2422. [PMID: 33851465 DOI: 10.1002/hed.26707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Lateral skull base tumors often necessitate temporal bone resection (TBR), although clinical outcomes can be unfavorable. Factors influencing survival and recurrence after TBR for cutaneous and salivary malignancies were evaluated. METHODS Twenty-six TBR subjects were included. Survival and recurrence outcomes were estimated at 1, 2, and 5 years postresection. Prognostic factors were analyzed using univariate and multivariate Cox regression. RESULTS Two years postresection, the overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) rates were 61%, 74%, and 49%, respectively, and 51%, 63%, and 45% at 5 years. On univariate analysis, preoperative facial nerve dysfunction and intraoperative nerve sacrifice worsened OS, DSS, and RFS. Prior surgery and adjuvant radiation independently predicted reduced OS, DSS, and RFS on multivariate analysis. CONCLUSIONS Mortality is highest in the first 2 years following resection. Preoperative facial nerve dysfunction, facial nerve sacrifice, and prior radiation are negative predictors of survival and recurrence.
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Affiliation(s)
- Neila L Kline
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kavita Bhatnagar
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David J Eisenman
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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14
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New proposal to revise the classification for squamous cell carcinoma of the external auditory canal and middle ear. The Journal of Laryngology & Otology 2021; 135:297-303. [PMID: 33785085 DOI: 10.1017/s002221512100089x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prognosis of patients with advanced squamous cell carcinoma of the external auditory canal and middle ear has been improved by advances in skull base surgery and multidrug chemoradiotherapy during the last two decades. METHODS Ninety-five patients with squamous cell carcinoma of the external auditory canal and middle ear who were treated between 1998 and 2017 were enrolled. The number of patients with tumour stages T1, T2, T3 and T4 was 15, 22, 24 and 34, respectively. Oncological outcomes and prognostic factors were retrospectively investigated. RESULTS Among patients with T4 disease, invasion of the brain (p = 0.024), carotid artery (p = 0.049) and/or jugular vein (p = 0.040) were significant predictors of poor prognosis. The five-year overall survival rate of patients with at least one of these factors (T4b) was significantly lower than that of patients without these factors (T4a) (25.5 vs 65.5 per cent, p = 0.049). CONCLUSION It is proposed that stage T4 be subclassified into T4a and T4b according to the prognostic factors.
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15
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A systematic review of the primary squamous cell carcinoma of the external auditory canal: survival outcome based on T-staging and proposal of a new classification. The Journal of Laryngology & Otology 2021; 135:96-103. [PMID: 33568243 DOI: 10.1017/s0022215121000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to provide a systematic review on survival outcome based on Pittsburgh T-staging for patients with primary external auditory canal squamous cell carcinoma. METHOD This study was a systematic review in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed until January 2018; pertinent studies were screened. Quality of evidence was assessed using the grading of recommendation, assessment, development and evaluation working group system. RESULTS Eight articles were chosen that reported on 437 patients with external auditory carcinoma. The 5-year overall survival rate was 53.0 per cent. The pooled proportion of survivors at 5 years for T1 tumours was 88.4 per cent and for T2 tumours was 88.6 per cent. For the combined population of T1 and T2 cancer patients, it was 84.5 per cent. For T3 and T4 tumours, it was 53.3 per cent and 26.8 per cent, respectively, whereas for T3 and T4 tumours combined, it was 40.4 per cent. Individual analysis of 61 patients with presence of cervical nodes showed a poor survival rate. CONCLUSION From this review, there was not any significant difference found in the survival outcome between T1 and T2 tumours. A practical classification incorporating nodal status that accurately stratifies patients was proposed.
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16
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Katano A, Takenaka R, Yamashita H, Ando M, Yoshida M, Saito Y, Asakage T, Abe O, Nakagawa K. A retrospective analysis of radiotherapy in the treatment of external auditory canal carcinoma. Mol Clin Oncol 2021; 14:45. [PMID: 33575029 DOI: 10.3892/mco.2021.2207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/13/2020] [Indexed: 11/06/2022] Open
Abstract
External auditory canal carcinoma (EACC) is a rare disease. The current study aimed to evaluate the clinical outcomes of patients treated with external beam radiotherapy (EBRT) for EACC. The present study retrospectively reviewed 34 consecutive patients treated for EACC with EBRT between February 2001 and January 2019 at the University of Tokyo Hospital. Clinical staging was performed according to the modified Pittsburgh classification. Of all the included patients, seven patients were in the early stages (I or II) and 27 in the advanced stages (III or IV) of EACC. A total of 16 patients underwent EBRT and surgery (S+RT) pre- and/or postoperatively, while 18 patients underwent definitive radiotherapy (dRT). The median prescribed doses for the S+RT and dRT groups were 66 and 70 Gy, respectively. The median follow-up period for all patients was 22.4 months (range, 2-205 months). The 5-year overall survival rates of the S+RT and dRT groups were 66.7 and 45.1%, respectively. The progression-free survival rate at 5-year was 55.6% (95% confidence interval: 36.5-71.1%) for the entire cohort. A total of 14 patients experienced disease relapse after treatment, consisting of 11 locoregional recurrences and three distant metastases. The current study revealed the clinical outcomes of EBRT for EACC.
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Affiliation(s)
- Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryousuke Takenaka
- Department of Radiology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hideomi Yamashita
- Department of Radiology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Mizuo Ando
- Department of Otolaryngology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masafumi Yoshida
- Department of Otolaryngology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuki Saito
- Department of Otolaryngology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Osamu Abe
- Department of Radiology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Keiichi Nakagawa
- Department of Radiology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo 113-8655, Japan
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17
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Alam U, Shafqat I, Ahsan S, Alonso J, Han AY, Mukdad L, Wang M, Ahsan SF. Survival in Middle Ear Malignancy: A Population-Based Analysis Based on the SEER Database. Otolaryngol Head Neck Surg 2021; 165:122-128. [PMID: 33400624 DOI: 10.1177/0194599820980708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinical features and survival outcomes of patients with middle ear malignancies at a population level. STUDY DESIGN Retrospective cohort study with data from a national database. SETTING National database of middle ear malignancy. METHODS Records of patients diagnosed with a middle ear malignancy from 1973 to 2016 were extracted from the SEER database (Surveillance, Epidemiology, and End Results). SPSS (version 27; IBM) was used to conduct 5-year survival analysis. RESULTS The average survival for all 431 patients was 61.4 months. Five-year disease-specific survival for squamous cell carcinoma (SCCA), adenocarcinoma, other carcinoma, and noncarcinoma subtypes varied significantly at 54.6%, 82.1%, 71.8%, and 82.6%, respectively (P < .0001). There was an improved 5-year survival for patients with adenocarcinoma who received surgery versus those who did not (91.7% vs 65.1%; P = .023, log-rank). Five-year disease-specific survival was significantly better in patients aged <55 years (mean ± SD, 77.8% ± 0.39%) as compared with those >70 years (55.1% ± 5.1%) and those aged 55 to 69 years (60.2% ± 4.9%; P < .01 and P < .001, respectively, log-rank). Patients with SCCA were significantly older than those with adenocarcinoma (P < .0001). Noncarcinoma subtypes were more likely to present with local disease, as opposed to regional or distant disease, when compared with SCCA (P = .0027). CONCLUSION Prognosis and treatment outcomes for primary middle ear malignancies depend on histologic subtype and age at diagnosis. The noncarcinoma and adenocarcinoma subtypes carry the best prognoses. Patients with adenocarcinoma were most likely to benefit from surgery.
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Affiliation(s)
- Usman Alam
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Iram Shafqat
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Sara Ahsan
- University of California, Berkeley, California, USA
| | - Jose Alonso
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Albert Y Han
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Laith Mukdad
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Marilene Wang
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Syed F Ahsan
- Department of Head and Neck Surgery, Kaiser Permanente, Anaheim, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
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18
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Shiga K, Nibu KI, Fujimoto Y, Asakage T, Homma A, Mitani H, Ogawa T, Okami K, Murono S, Hirano S, Ueda T, Hanai N, Tsukahara K, Ota I, Yoshimoto S, Shinozaki T, Iwae S, Katagiri K, Saito D, Kiyota N, Tahara M, Takahashi F, Hayashi R. Multi-institutional Survey of Squamous Cell Carcinoma of the External Auditory Canal in Japan. Laryngoscope 2020; 131:E870-E874. [PMID: 33216374 DOI: 10.1002/lary.28936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study aimed to evaluate the efficacy of chemoradiotherapy (CRT) for patients with advanced cancer of the external auditory canal (EAC) by analyzing the outcome of the patients. METHODS This is a multi-institutional retrospective survey, and we reviewed the medical records of the subjects. A total of 181 patients with tumor (T)3 or T4 tumor in 17 institutions were enrolled. Further analysis was performed for 74 patients who underwent CRT under curative intent. RESULTS Overall 5-year survival rates of the patients who underwent CRT (n = 74) were 54.6%. Those of the patients who underwent CRT with modified TPF (docetaxel, cisplatin [CDDP], and 5-fluorouracil) regimen (n = 50) and CRT with CDDP regimens (n = 24) were 64.4% and 36.7%, respectively. Significant differences were observed between these two groups. CONCLUSION Given the tendency that head and neck surgeons prefer CRT for advanced larger cancer of the EAC, CRT for advanced EAC cancer using the modified TPF regimen showed good clinical outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E870-E874, 2021.
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Affiliation(s)
- Kiyoto Shiga
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Mitani
- Department of Head and Neck Surgery, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Takenori Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan
| | - Kenji Okami
- Department of Otolaryngology, Tokai University School of Medicine, Hiratsuka, Japan
| | - Shigeyuki Murono
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsutomu Ueda
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Shinjuku-ku, Japan
| | - Ichiro Ota
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shigemichi Iwae
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Katsunori Katagiri
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Daisuke Saito
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Naomi Kiyota
- Department of Medical Oncology/Hematology, Kobe University Hospital Cancer Center, Kobe, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Fumiaki Takahashi
- Division of Medical Engineering, Department of Information Science, Iwate Medical University, Yahaba, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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Iwami K, Fujii M, Nishio N, Maruo T, Fujimoto Y, Takanari K, Kamei Y, Yamada M, Ogawa T, Osuka K, Saito K. Skull Base Invasion Patterns of Malignant Head and Neck Tumors: A Neurosurgical Perspective. J Neurol Surg B Skull Base 2020; 82:e120-e130. [PMID: 34306927 DOI: 10.1055/s-0039-3402034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/09/2019] [Indexed: 12/26/2022] Open
Abstract
Objective Craniofacial resection (CFR) and temporal bone resection (TBR) on malignant head and neck tumors (MHNTs) invading skull base require accurate and precise determination of the tumor invasion. We investigated tumor skull base invasion patterns and surgical results in CFR and TBR cases. Methods We performed either CFR or TBR for 75 selected patients with the possibility of en bloc resection over the period between 2011 and 2018. The medical charts of the selected patients were reviewed. Results Primary tumor onset site (TOS) groups were: (1) nasal cavity/ethmoid sinus, 20 cases; (2) orbit, 10 cases; (3) maxillary sinus, 28 cases; and (4) external ear/temporomandibular joint, 17 cases. Grades for tumor invasion depth (TID) included: (I) extracranial invasion and skull base bone invasion; (II) extradural invasion; or (III) intradural invasion. Patients in groups 1 and 2 had a significantly higher frequency of grade II and III invasions than patients in groups 3 and 4. The main invasion site was nasal cavity superior wall and ethmoid sinus superior wall for group 1 tumors, orbit superior wall, and lateral skull base sphenoid bone for group 2 and 3 tumors, and lateral skull base temporal bone for group 4 tumors. Positive resection margins represented a significant negative prognostic factor. TID and TOS did not affect skull base margin status. Conclusion Skull base invasion of MHNTs exhibits certain fixed patterns in sites susceptible to invasion based on the TOS. The frequencies of extradural and intradural invasions differed, indicating the importance for accurate preoperative tumor evaluation.
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Affiliation(s)
- Kenichiro Iwami
- Department of Neurosurgery, Aichi Medical University, Aichi, Japan
| | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayuki Yamada
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Tetsuya Ogawa
- Department of Otorhinolaryngology, Aichi Medical University, Aichi, Japan
| | - Koji Osuka
- Department of Neurosurgery, Aichi Medical University, Aichi, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
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Lovin BD, Gidley PW. Squamous cell carcinoma of the temporal bone: A current review. Laryngoscope Investig Otolaryngol 2019; 4:684-692. [PMID: 31890889 PMCID: PMC6929568 DOI: 10.1002/lio2.330] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Benjamin D. Lovin
- Bobby R. Alford Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexas
| | - Paul W. Gidley
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexas
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21
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Nagano T, Yoshimura RI, Kojima M, Nakagawa K, Toda K. Outcomes of radiotherapy in advanced external auditory canal cancer. JOURNAL OF RADIATION RESEARCH 2019; 60:380-386. [PMID: 31116854 PMCID: PMC6530620 DOI: 10.1093/jrr/rrz010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/22/2018] [Indexed: 06/09/2023]
Abstract
External auditory canal cancer (EACC) is a rare malignant tumor. In the present study, we retrospectively evaluated the treatment results in patients with advanced EACC who were treated using external-beam radiotherapy (EBRT) combined with chemotherapy or radical surgery. Overall, 21 patients with Stage III (n = 8) or Stage IV (n = 13) EACC who underwent initial treatment at our hospital between 2003 and 2016 were enrolled in this study. The 2-year overall survival (OS) and locoregional control (LRC) rates of all patients were 62% and 71%, respectively. The 2-year OS and LRC rates in patients who had received EBRT and concurrent chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF, n = 6) were 100%. These results were higher than the 2-year OS and LRC rates of 62% and 69%, respectively, in patients who had received radical surgery and EBRT (n = 13). The rates were 0% in those who had neither received TPF nor undergone surgery in addition to EBRT (n = 2). Grade 3 bone or soft tissue necrosis was observed in 2 patients who had undergone surgery and postoperative EBRT. Our data suggest that the combination therapy of EBRT and surgery and/or chemotherapy may be the most effective treatment options for advanced EACC, and EBRT with concurrent chemotherapy with TPF is potentially the most acceptable.
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Affiliation(s)
- Takuya Nagano
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Ryo-ichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Mio Kojima
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Keiko Nakagawa
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Kazuma Toda
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
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Hayashi K, Koto M, Demizu Y, Saitoh JI, Suefuji H, Okimoto T, Ohno T, Shioyama Y, Takagi R, Ikawa H, Nemoto K, Nakano T, Kamada T. A retrospective multicenter study of carbon-ion radiotherapy for external auditory canal and middle ear carcinomas. Cancer Med 2018; 8:51-57. [PMID: 30548207 PMCID: PMC6346229 DOI: 10.1002/cam4.1830] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 12/14/2022] Open
Abstract
Background We conducted a retrospective multicenter study to assess the clinical outcomes of carbon‐ion radiotherapy (CIRT) for head and neck malignancies (Japan Carbon‐Ion Radiation Oncology Study Group [J‐CROS] study: 1402 HN). We aimed to evaluate the safety and efficacy of CIRT in patients with external auditory canal (EAC) and middle ear (ME) carcinomas. Methods Thirty‐one patients treated with CIRT at four Japanese institutions were analyzed. Fourteen patients (45.2%) had squamous cell carcinomas, 13 (41.9%) had adenoid cystic carcinomas, and four (12.9%) had other types. Nineteen (61.3%), six (19.4%), three (9.7%), and three (9.7%) patients had T4, T3, T2, and T1 disease, respectively. All patients had N0M0 status. The median radiation dose was 64 Gy (relative biological effectiveness) in 16 fractions. The median gross tumor volume was 33.3 mL. Results The median follow‐up period was 18.4 months (range, 5.1‐85.6). The 1‐ and 3‐year local control and overall survival rates were 75.0% and 55.0% and 79.3% and 58.7%, respectively. Regarding grade 3 or higher toxicities, three patients (9.7%) had grade 3 dermatitis, one (3.2%) had grade 3 mucositis, and two (6.5%) had grade 3 central nervous necrosis (ie, radiation‐induced brain necrosis). No grade 4 or worse reactions were observed. Conclusion CIRT was effective for EAC and ME carcinomas.
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Affiliation(s)
- Kazuhiko Hayashi
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Masashi Koto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Jun-Ichi Saitoh
- Department of Radiology, University of Toyama, Toyama, Japan
| | | | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Tatsuya Ohno
- Medicine & Biology Division, Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | | | - Ryo Takagi
- Department of Oral Surgery, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan
| | - Hiroaki Ikawa
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Takashi Nakano
- Medicine & Biology Division, Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Tadashi Kamada
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
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Park JM, Kong JS, Chang KH, Jun BC, Jeon EJ, Park SY, Park SN, Park KH. The Clinical Characteristics and Surgical Outcomes of Carcinoma of the External Auditory Canal: A Multicenter Study. J Int Adv Otol 2018; 14:278-284. [PMID: 30256202 PMCID: PMC6354453 DOI: 10.5152/iao.2018.4952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/13/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the clinical characteristics and evaluate the surgical outcomes of carcinoma of the external auditory canal (CEAC). MATERIALS AND METHODS Overall, 31 patients from four multicenter hospitals, who were diagnosed and surgically treated for CEAC in 2009-2014, were enrolled for this retrospective study. Medical records were reviewed to determine cancer stage according to the Pittsburgh classification. Clinical data of age, sex, site, initial symptoms, surgery extent, postoperative complications including recurrence, follow-up period, and current patient status were collected for analysis. Five-year cumulative survival rate was obtained using Kaplan-Meier method. RESULTS At initial diagnosis, 22 patients were in the early stages (stage I: 15; stage II: 7) and 9 patients were in the advanced stages (stage III: 1; stage IV: 8). Lymph node metastasis was present in 5 patients and distant metastasis in 2. Of the 31 patients, 4 patients died (stage II: 1, stage IV: 3) during the follow-up period. Early-stage patients showed 100% 5-year estimated cumulative survival rate, whereas the advanced-stage patients showed 5-year estimated survival rate of 53.6% (p=.006). The overall survival rate of all enrolled patients was 90.3%. Although 5-year estimated disease-free survival rate of stage I was 100.0%, that for stage II was low at 30.0% because of considerable recurrences. CONCLUSION The results of this multicenter study suggest that more aggressive treatment modality, including adjuvant therapy, is necessary for patients with CEAC with Pittsburgh stage II or more.
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Affiliation(s)
- Jung Mee Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Sun Kong
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Hong Chang
- Department of Otolaryngology-Head and Neck Surgery, Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Beom Cho Jun
- Department of Otolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Ju Jeon
- Department of Otolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - So Young Park
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shi Nae Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung Ho Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Abstract
INTRODUCTION Malignancy of the middle ear is a rare condition with limited data available for clinical guidance. STUDY DESIGN Retrospective evaluation of a large national database. SETTING Deidentified national cancer database. PATIENTS Subjects with diagnosis of malignancy of the middle ear in the National Cancer Database between 2004 and 2012. MAIN OUTCOME MEASURES Demographic information and tumor characteristics were evaluated. The primary endpoint of interest is overall survival. RESULTS The most common histology was squamous cell carcinoma (SCC) (50%). Multivariable Cox proportional hazard analysis found the following variables had a significant negative impact on overall survival: age (HR 1.04 95% CI [1.02-1.05]), squamous cell carcinoma, not otherwise specified (NOS) (HR 2.08 95% CI [1.30-3.32]), squamous cell carcinoma, keratinizing, NOS (HR 4.20 95% CI [2.14-8.24]), embroynal rhabdomyosarcoma, NOS (HR 4.96 95% CI [1.17-21.11]), and unknown extension (HR 2.87 95% CI [1.22-6.74]). For patients of SCC who underwent surgery, 30 had positive margins and 29 underwent adjuvant radiation. For these, no survival advantage was found with the addition of chemotherapy, regardless of node status. CONCLUSION Malignancy of the middle ear is a rare condition with prognosis that depends on histology. The most common histology, SCC, is associated with the poorest overall survival. Evaluation of large national datasets can add significantly to the understanding of such uncommon tumors.
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25
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Matoba T, Hanai N, Suzuki H, Nishikawa D, Tachibana E, Okada T, Murakami S, Hasegawa Y. Treatment and Outcomes of Carcinoma of the External and Middle Ear: The Validity of En Bloc Resection for Advanced Tumor. Neurol Med Chir (Tokyo) 2017; 58:32-38. [PMID: 29142161 PMCID: PMC5785695 DOI: 10.2176/nmc.oa.2017-0133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Carcinoma of the external and middle ear is a very rare disease. Despite the various treatment modalities available, its prognosis is still poor. We aimed to analyze the treatment modalities, outcomes, and validity of surgical approaches, especially in advanced tumors in the ear. Twenty-five patients with carcinoma of the external and middle ear were retrospectively analyzed. The modified Pittsburgh staging system was used for staging of the patients. Overall and disease-free survival was estimated using of Kaplan-Meier method. In our cohort of 25 patients, the majority (76%) had tumor located in external auditory meatus. The most common histologic subtype was squamous cell carcinoma (80%). More than half of patients (56%) had tumor stage IV. In the stage IV group, five patients underwent subtotal temporal bone resection and ipsilateral neck dissection. Seven patients underwent definitive radiotherapy. The remaining two patients underwent palliative chemotherapy. The 2-year overall and disease-free survival for patients with tumor stage IV was 67.7% and 57.8%, respectively. In patients with tumor stage IV, the 2-year overall survival for patients who underwent surgery was 80.0% versus 53.6% for those who underwent radiotherapy (P = 0.16). The 2-year disease-free survival for patients who underwent surgery was 80.0% versus 28.6% for those who underwent radiotherapy (P = 0.15). In the present study, the outcome of patients who received surgical treatment tended to be better than that of patients who received radiation therapy. Our results suggest that en bloc resection could be the first choice even in the advanced disease stage.
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Affiliation(s)
- Takuma Matoba
- Department of Otorhinolaryngology and Head and Neck Surgery, Nagoya City University Hospital.,Department of Head and Neck Surgery, Aichi Cancer Center Hospital
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital
| | - Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital
| | | | | | | | - Shingo Murakami
- Department of Otorhinolaryngology and Head and Neck Surgery, Nagoya City University Hospital
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Surgery With or Without Postoperative Radiation Therapy for Early-stage External Auditory Canal Squamous Cell Carcinoma: A Meta-analysis. Otol Neurotol 2017; 38:1333-1338. [DOI: 10.1097/mao.0000000000001533] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Ebisumoto K, Okami K, Hamada M, Maki D, Sakai A, Saito K, Shimizu F, Kaneda S, Iida M. Cetuximab with radiotherapy as an alternative treatment for advanced squamous cell carcinoma of the temporal bone. Auris Nasus Larynx 2017; 45:637-639. [PMID: 28867454 DOI: 10.1016/j.anl.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/19/2017] [Accepted: 08/09/2017] [Indexed: 12/24/2022]
Abstract
The prognosis of advanced temporal bone cancer is poor, because complete surgical resection is difficult to achieve. Chemoradiotherapy is one of the available curative treatment options; however, its systemic effects on the patient restrict the use of this treatment. A 69-year-old female (who needed peritoneal dialysis) presented at our clinic with T4 left external auditory canal cancer and was treated with cetuximab plus radiotherapy (RT). The primary lesion showed complete response. The patient is currently alive with no evidence of disease two years after completion of the treatment and does not show any late toxicity. This is the first advanced temporal bone cancer patient treated with RT plus cetuximab. Cetuximab plus RT might be a treatment alternative for patients with advanced temporal bone cancer.
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Affiliation(s)
- Koji Ebisumoto
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan.
| | - Kenji Okami
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Masashi Hamada
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Daisuke Maki
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Akihiro Sakai
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Kosuke Saito
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Fukuko Shimizu
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Shoji Kaneda
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiro Iida
- Department of Otolaryngology-Head Neck Surgery, Tokai University, Isehara, Kanagawa, 259-1193, Japan
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Wei L, Wang L, Liu Z, Wang M, Lu W, Zhao D, Yang B, Kong X, Ding Y, Wang Z. Dramatic response of CTNNB1 and VEGFR-2 mutant temporal bone squamous cell carcinoma to bevacizumab in combination with pemetrexed. Oncotarget 2017; 8:57898-57904. [PMID: 28915721 PMCID: PMC5593693 DOI: 10.18632/oncotarget.19649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 07/18/2017] [Indexed: 12/11/2022] Open
Abstract
High recurrence rates and poor survival rates for late stage/advanced temporal bone squamous cell carcinoma with the standard treatments continues to be a significant challenge to otolaryngologists. Targeted therapy for temporal bone squamous cell carcinoma after relapse has not been reported. Here we present a 58-year-old man who was diagnosed with recurrent temporal bone squamous cell carcinoma and treated with a regimen developed using whole exome sequencing. Somatic mutations in genes encoding catenin beta 1 and vascular endothelial growth factor receptor 2 were identified in the patient’s tumor sample compared to the normal tissue. The patient was then treated with Bevacizumab in combination with pemetrexed. After two weeks of treatment, tumor volume was reduced by 95% measured by MRI, and the Visual Analogue Scale headache scores went down from 10/10 to 2/10. Our results reveal novel gene mutations of temporal bone squamous cell carcinoma and demonstrate, for the first time, an effective targeted therapy for temporal bone squamous cell carcinoma. The successful treatment regimen of bevacizumab and pemetrexed may provide a new treatment option for treating recurrent temporal bone squamous cell carcinoma that fails to respond to conventional tumor resection, radiotherapy, and/or chemotherapy.
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Affiliation(s)
- Lai Wei
- Department of Otolaryngology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Lizhi Wang
- Department of Otolaryngology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ziye Liu
- Department of Otolaryngology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Meiyi Wang
- Department of Otolaryngology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Weili Lu
- Department of Otolaryngology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Dewei Zhao
- The Institute for Translational Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Bin Yang
- The Institute for Translational Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xuejun Kong
- Department of Pediatrics, Children's Hospital of Boston, Harvard Medical School, Boston, MA, USA
| | - Yan Ding
- The Institute for Translational Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.,Department of Pediatrics, Children's Hospital of Boston, Harvard Medical School, Boston, MA, USA.,Program for Autism Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhiqiang Wang
- Department of Otolaryngology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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29
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Murai T, Kamata SE, Sato K, Miura K, Inoue M, Yokota N, Ohta S, Iwabuchi M, Iwata H, Shibamoto Y. Hypofractionated Stereotactic Radiotherapy for Auditory Canal or Middle Ear Cancer. Cancer Control 2017; 23:311-6. [PMID: 27556672 DOI: 10.1177/107327481602300315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Stereotactic radiotherapy (SRT) may represent a new treatment option for individuals with auditory canal or middle ear cancer. METHODS Study participants with pathologically proven ear cancer were treated with SRT (35 Gy for 3 fractions or 40 Gy for 5 fractions) as first-line therapy. When local tumor recurrence developed following SRT, subtotal temporal bone resection and postoperative chemoradiotherapy were performed as salvage treatment. Boluses were used for the initial 14 study patients. RESULTS Twenty-nine study participants were enrolled and staged with T1 (n = 3), T2 (n = 7), T3 (n = 14), or T4 disease (n = 5). Three-year overall survival rates were 69% for T1/2 disease, 79% for T3 disease, and 0% for T4 disease. Three-year local control rates were 70% for T1/2 disease, 50% for T3 disease, and 20% for T4 disease. Grade 2 or higher dermatitis or soft-tissue necrosis occurred more frequently in study patients treated with boluses (8/14 vs 2/15; P = .02). Salvage treatment was safely performed for 12 recurrent cases. CONCLUSIONS These results suggest that SRT outcomes are promising for patients with ear cancer (? T3 disease). The rate of toxicity was acceptable in the study patients treated without boluses. Outcomes of salvage surgery and postoperative radiotherapy following SRT were also encouraging.
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Affiliation(s)
- Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
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30
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Wang Z, Zheng M, Xia S. The contribution of CT and MRI in staging, treatment planning and prognosis prediction of malignant tumors of external auditory canal. Clin Imaging 2016; 40:1262-1268. [PMID: 27639864 DOI: 10.1016/j.clinimag.2016.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 08/16/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
Abstract
Carcinomas of external auditory canal (EAC) are rare. Radiological imaging particular in computed tomography (CT) and magnetic resonance imaging (MRI) plays an important role in the staging, treatment planning and follow up of the patients with malignant EAC tumor. This article aims to review the role of CT and MRI in the describing different tumor growth pattern, tumor staging, treatment planning, follow up and predicting the prognosis of malignant tumors of EAC.
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Affiliation(s)
- Zhiye Wang
- Department of Radiology, Yuhuang Ding Hospital Yantai, Shandong, China, 264000
| | - Meizhu Zheng
- Departments of Radiology, Tianjin Third Central Hospital, Tianjin, China, 300000
| | - Shuang Xia
- Departments of Radiology, Tianjin First Central Hospital, Tianjin, China, 300192.
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31
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Choi J, Kim SH, Koh YW, Choi EC, Lee CG, Keum KC. Tumor Stage-Related Role of Radiotherapy in Patients with an External Auditory Canal and Middle Ear Carcinoma. Cancer Res Treat 2016; 49:178-184. [PMID: 27384159 PMCID: PMC5266398 DOI: 10.4143/crt.2016.165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/03/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes of patients treated with radiotherapy (RT) for a carcinoma of the external auditory canal (EAC) and middle ear. MATERIALS AND METHODS The records of 32 patients who received RT from 1990 to 2013 were reviewed retrospectively. The Pittsburgh classification was used to stage all the cancers (early stage, T1/T2 [n=12]; advanced stage, T3/T4 or N positive [n=20]). Twenty-one patients (65.6%) were treated with postoperative RT and 11 patients (34.4%) were treated with definitive RT. The median radiation doses for postoperative and definitive RT were 60 Gy and 64.8 Gy, respectively. Chemotherapy was administered to seven patients (21.9%). RESULTS The 5-year overall survival and disease-free survival rates for all patients were 57% and 52%, respectively. The disease control rates for the patients with early stage versus advanced stage carcinomawere 55.6% (5/9) and 50% (6/12) in the postoperative RT group and 66.7% (2/3) and 37.5% (3/8) in the definitive RT group, respectively. Overall, 15 cases (14 patients, 46.7%) experienced treatment failure; these failures were classified as local in four cases, regional in one case, and distant in 10 cases. The median follow-up period after RT was 51 months (range, 7 to 286 months). CONCLUSION Patients with early stage carcinoma achieved better outcomes when definitive RT was used. Advanced stage carcinoma patients experienced better outcomes with postoperative RT. The high rate of distant failure after RT, with or without surgery, reflected the lack of a consensus regarding the best therapeutic approach for treating carcinoma of the EAC and middle ear.
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Affiliation(s)
- Jinhyun Choi
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Gandhi AK, Roy S, Biswas A, Raza MW, Saxena T, Bhasker S, Sharma A, Thakar A, Mohanti BK. Treatment of squamous cell carcinoma of external auditory canal: A tertiary cancer centre experience. Auris Nasus Larynx 2016; 43:45-9. [DOI: 10.1016/j.anl.2015.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 05/13/2015] [Accepted: 06/22/2015] [Indexed: 11/25/2022]
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Zanoletti E, Lovato A, Stritoni P, Martini A, Mazzoni A, Marioni G. A critical look at persistent problems in the diagnosis, staging and treatment of temporal bone carcinoma. Cancer Treat Rev 2015; 41:821-6. [DOI: 10.1016/j.ctrv.2015.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 01/23/2023]
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Homma A, Onimaru R, Matsuura K, Robbins KT, Fujii M. Intra-arterial chemoradiotherapy for head and neck cancer. Jpn J Clin Oncol 2015; 46:4-12. [PMID: 26486825 DOI: 10.1093/jjco/hyv151] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/29/2015] [Indexed: 02/05/2023] Open
Abstract
Intra-arterial chemotherapy has been used to treat localized malignant neoplasms in patients with head and neck cancer for over 50 years as the head and neck region is particularly well suited to regional chemotherapy. Early intra-arterial chemotherapy did not prove its efficacy. In addition, the additional complications associated with establishing and maintaining arterial access have further dampened enthusiasm for this approach. Subsequent significant advances in vascular radiology techniques and the development of new devices, such as fluoroscopy units and angiographic catheters, have made possible safe, accurate and repeated superselective intra-arterial chemotherapy. Intra-arterial infusion of high-dose cisplatin with systemic neutralization by intravenous sodium thiosulfate (RADPLAT) is a theoretically attractive approach to the treatment of advanced head and neck cancer. However, a Dutch trial comparing intra-arterial and intravenous chemoradiotherapy for advanced head and neck cancer showed that RADPLAT was not superior to intravenous chemoradiotherapy. Therefore, further investigation of RADPLAT, including the refinement of the indications for its application, is needed.
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Affiliation(s)
- Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine
| | - Rikiya Onimaru
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo
| | - Kazuto Matsuura
- Division of Head and Neck Surgery, Miyagi Cancer Center, Sendai, Japan
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Masato Fujii
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Feng L, Jin A, Dai B, Li Y, Guo Y, Wang D, Xu P. Outcomes of 18 cases with squamous cell carcinoma of middle ear who underwent both surgery and post-operative radiotherapy. Acta Otolaryngol 2015; 136:141-3. [PMID: 26472473 DOI: 10.3109/00016489.2015.1094825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Early diagnosis and treatment were critical to prevent recurrence, and the long-term outcomes were satisfactory after surgery and post-operative radiotherapy. OBJECTIVES To present outcomes of 18 cases with squamous cell carcinoma of the middle ear who underwent both surgery and post-operative radiotherapy. METHODS Eighteen cases with squamous cell carcinoma of the middle ear (two cases of T1, five of T2, and 11 of T3) underwent surgery and post-operative radiotherapy, and a surgical approach was determined by tumour sites. Extended mastoidotympanectomy was performed on two cases, with subtotal temporal bone resection on 12 cases and temporal bone resection on four cases. The patients who had cervical metastasis underwent additional radical neck resection and post-operative radiotherapy at the neck. The patients were followed-up after surgery. RESULTS During the follow-up, no cases of T1 recurred, and six cases of T2 or T3 recurred, with the total recurrence rate of 37.5% among the patients of T2 and T3. At the fifth year after surgery, 15 patients were still alive, and the actual 5-year survival rate was 83.3% among all patients.
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Affiliation(s)
- Lichun Feng
- a Department of Otolaryngology , Cangzhou Central Hospital , Cangzhou , Hebei Province , PR China
| | - Aiyan Jin
- a Department of Otolaryngology , Cangzhou Central Hospital , Cangzhou , Hebei Province , PR China
| | - Baoqiang Dai
- a Department of Otolaryngology , Cangzhou Central Hospital , Cangzhou , Hebei Province , PR China
| | - Yanping Li
- a Department of Otolaryngology , Cangzhou Central Hospital , Cangzhou , Hebei Province , PR China
| | - Yusheng Guo
- b Department of Otolaryngology , People's Hospital of Yanshan County , Cangzhou , PR China
| | - Daowen Wang
- c Department of Otolaryngology, Head and Neck Surgery , Peking University Health Science Center , Beijing , PR China
| | - Peng Xu
- a Department of Otolaryngology , Cangzhou Central Hospital , Cangzhou , Hebei Province , PR China
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Clinical and pathological parameters prognostic for increased risk of recurrence after postoperative radiotherapy for temporal bone carcinoma. Head Neck 2015; 38:894-8. [DOI: 10.1002/hed.24221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/10/2015] [Accepted: 07/20/2015] [Indexed: 12/23/2022] Open
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Gallegos-Hernández JF, Martínez-Méndez MÁ, Ábrego-Vázquez JA, Hernández-Sanjuan M, Minauro-Muñoz GG, Ortiz-Maldonado AL. [Clinical characteristics of malignant tumours originating in the external ear]. CIR CIR 2015; 83:473-7. [PMID: 26183026 DOI: 10.1016/j.circir.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Skin tumours that originate in the external ear are common in individuals with type 1 skin and phenotype 1 and 2. The skin cancer is associated with chronic or intermittent, but intense sunlight. The most common malignant tumour is basal cell carcinoma, followed by squamous cell carcinoma and melanoma. The diagnosis of squamous cell skin cancer in head and neck area is usually made in the advanced stages and has a poor prognosis. MATERIAL AND METHODS A cross-sectional, retrospective analysis was performed on the database of patients with skin cancer of the external ear treated between 2011 and 2014. Histology type, stage, rate of clinical and occult metastases, and rate of loco-regional recurrence were evaluated. RESULTS Of the 42 patients included there were, 25 squamous cell carcinomas, 11 basal cell carcinomas, and 6 invasive melanomas. The rate of lymph node metastases in patients with squamous cell carcinoma was 32%, mostly in the parotid and peri-parotid region, 7% of them with capsular rupture, 2/17 were staged as cN0, and 11.7% had occult metastases. All patients with nodal metastasis were classified as T2 with ulceration. None of the patients with basal cell carcinoma had lymph node metastases. All melanomas were superficial extension type with mean level of Breslow of 3 mm. All underwent lymphatic mapping and sentinel node biopsy, with only one having metastases in the sentinel node. CONCLUSION The most frequent tumour in the external ear in this series was squamous cell carcinoma. The possibility of lymph node metastases is associated with tumour size (T). Node dissection should be systematic in patients with T2 or greater.
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Affiliation(s)
- José Francisco Gallegos-Hernández
- Departamento de Tumores de Cabeza, Cuello y Piel, Hospital de Oncología, Centro Médico Nacional Siglo xxi. Instituto Mexicano del Seguro Social, México, D.F., México.
| | - Miguel Ángel Martínez-Méndez
- Departamento de Tumores de Cabeza, Cuello y Piel, Hospital de Oncología, Centro Médico Nacional Siglo xxi. Instituto Mexicano del Seguro Social, México, D.F., México
| | - José Alberto Ábrego-Vázquez
- Departamento de Tumores de Cabeza, Cuello y Piel, Hospital de Oncología, Centro Médico Nacional Siglo xxi. Instituto Mexicano del Seguro Social, México, D.F., México
| | - Martín Hernández-Sanjuan
- Departamento de Tumores de Cabeza, Cuello y Piel, Hospital de Oncología, Centro Médico Nacional Siglo xxi. Instituto Mexicano del Seguro Social, México, D.F., México
| | - Gerardo Gabriel Minauro-Muñoz
- Departamento de Tumores de Cabeza, Cuello y Piel, Hospital de Oncología, Centro Médico Nacional Siglo xxi. Instituto Mexicano del Seguro Social, México, D.F., México
| | - Alma Lilia Ortiz-Maldonado
- Departamento de Tumores de Cabeza, Cuello y Piel, Hospital de Oncología, Centro Médico Nacional Siglo xxi. Instituto Mexicano del Seguro Social, México, D.F., México
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Koto M, Hasegawa A, Takagi R, Sasahara G, Ikawa H, Mizoe JE, Jingu K, Tsujii H, Kamada T, Okamoto Y. Carbon ion radiotherapy for locally advanced squamous cell carcinoma of the external auditory canal and middle ear. Head Neck 2015; 38:512-6. [DOI: 10.1002/hed.23905] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/11/2014] [Accepted: 10/24/2014] [Indexed: 02/03/2023] Open
Affiliation(s)
- Masashi Koto
- Research Center for Charged Particle Therapy Hospital; National Institute of Radiological Sciences; Chiba Japan
| | - Azusa Hasegawa
- Research Center for Charged Particle Therapy Hospital; National Institute of Radiological Sciences; Chiba Japan
| | - Ryo Takagi
- Research Center for Charged Particle Therapy Hospital; National Institute of Radiological Sciences; Chiba Japan
| | - Go Sasahara
- Research Center for Charged Particle Therapy Hospital; National Institute of Radiological Sciences; Chiba Japan
| | - Hiroaki Ikawa
- Research Center for Charged Particle Therapy Hospital; National Institute of Radiological Sciences; Chiba Japan
| | | | - Keiichi Jingu
- Department of Radiation Oncology; Tohoku University School of Medicine; Sendai Japan
| | - Hirohiko Tsujii
- Research Center for Charged Particle Therapy Hospital; National Institute of Radiological Sciences; Chiba Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy Hospital; National Institute of Radiological Sciences; Chiba Japan
| | - Yoshitaka Okamoto
- Department of Otolaryngology; Chiba University School of Medicine; Chiba Japan
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Ihler F, Koopmann M, Weiss BG, Dröge LH, Durisin M, Christiansen H, Weiß D, Canis M, Wolff HA. Surgical margins and oncologic results after carcinoma of the external auditory canal. Laryngoscope 2015; 125:2107-12. [DOI: 10.1002/lary.25381] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 01/28/2023]
Affiliation(s)
| | - Mario Koopmann
- Department of Otorhinolaryngology; University Hospital Muenster (m.k., d.w.); Muenster
| | | | - Leif Hendrik Dröge
- Department of Radiotherapy and Radiooncology; University Medical Center Göttingen; Göttingen
| | | | - Hans Christiansen
- Department of Radiotherapy and Radiooncology; Hannover Medical School; Hannover Germany
| | - Daniel Weiß
- Department of Otorhinolaryngology; University Hospital Muenster (m.k., d.w.); Muenster
| | | | - Hendrik A. Wolff
- Department of Radiotherapy and Radiooncology; University Medical Center Göttingen; Göttingen
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Kitani Y, Kubota A, Furukawa M, Sato K, Nakayama Y, Nonaka T, Mizoguchi N. Primary definitive radiotherapy with or without chemotherapy for squamous cell carcinoma of the temporal bone. Eur Arch Otorhinolaryngol 2015; 273:1293-8. [PMID: 25822291 DOI: 10.1007/s00405-015-3616-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
We aimed to evaluate the impact of concurrent chemoradiotherapy (CCRT) on the survival of patients with squamous cell carcinoma of the temporal bone. We retrospectively analyzed the data of 13 consecutive patients who were treated by definitive radiation therapy (RT) or CCRT as the initial treatment between 1999 and 2012. There were 5 patients with stage II disease, 5 with stage III, and 3 with stage IV, as classified according to the University of Pittsburgh system. Among these, 2, 4, and 3 patients, respectively, were treated by CCRT; whereas the remaining (3 patients with stage II and 1 with stage III) were treated by RT alone. Median follow-up duration was 39 months (12-106 months) in all cases, and 61.5 months (17-70 months) in censored cases. The 5-year overall survival (OS) rates were 51 % in all patients, and 40, 100, and 0 % in patients with stage II, stage III, and stage IV disease, respectively. In patients with stage II and III disease, the 5-year OS rates were 80 % in the CCRT group and 50 % in the RT-alone group. We found better prognosis in patients with stage II and III disease who were treated by CCRT. Only 2 patients treated by CCRT experienced adverse events more than grade 3, which were neutropenia and dermatitis. There was no late adverse event of bony necrosis. Our study results indicate that CCRT is safe and very effective as a first-line treatment for stage II and III squamous cell carcinoma of the temporal bone.
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Affiliation(s)
- Yosuke Kitani
- Department of Head and Neck Surgery, Kanagawa Cancer Center, Yokohama, Japan.
| | - Akira Kubota
- Department of Head and Neck Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Madoka Furukawa
- Department of Head and Neck Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kaname Sato
- Department of Head and Neck Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Tetsuo Nonaka
- Department of Radiation Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Nobutaka Mizoguchi
- Department of Radiation Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
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Fujiwara M, Yamamoto S, Doi H, Takada Y, Odawara S, Niwa Y, Ishikura R, Kamikonya N, Terada T, Uwa N, Sagawa K, Hirota S. Arterial chemoradiotherapy for carcinomas of the external auditory canal and middle ear. Laryngoscope 2014; 125:685-9. [DOI: 10.1002/lary.24908] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/22/2014] [Accepted: 08/04/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Masayuki Fujiwara
- Department of Radiology; Hyogo College of Medicine; Hyogo Japan
- Department of Radiation Oncology; Meiwa Cancer Clinic; Hyogo Japan
| | | | - Hiroshi Doi
- Department of Radiology; Hyogo College of Medicine; Hyogo Japan
| | - Yasuhiro Takada
- Department of Radiology; Hyogo College of Medicine; Hyogo Japan
| | - Soichi Odawara
- Department of Radiology; Hyogo College of Medicine; Hyogo Japan
| | - Yasue Niwa
- Department of Radiology; Hyogo College of Medicine; Hyogo Japan
| | | | | | - Tomonori Terada
- Department of Otolaryngology; Hyogo College of Medicine; Hyogo Japan
| | - Nobuhiro Uwa
- Department of Otolaryngology; Hyogo College of Medicine; Hyogo Japan
| | - Kosuke Sagawa
- Department of Otolaryngology; Hyogo College of Medicine; Hyogo Japan
| | - Shozo Hirota
- Department of Radiology; Hyogo College of Medicine; Hyogo Japan
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Takenaka Y, Cho H, Nakahara S, Yamamoto Y, Yasui T, Inohara H. Chemoradiation therapy for squamous cell carcinoma of the external auditory canal: A meta-analysis. Head Neck 2014; 37:1073-80. [PMID: 24692266 DOI: 10.1002/hed.23698] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 03/08/2014] [Accepted: 03/28/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The standard treatment for advanced external auditory canal squamous cell carcinoma (SCC) is subtotal temporal bone resection and postoperative radiation therapy (RT), whereas chemoradiation therapy (CRT) is used in some institutions to improve patient prognosis. The purpose of this study was to evaluate the efficacy of CRT in external auditory canal SCC treatment. METHODS Meta-analyses of external auditory canal SCC studies were performed. We extracted 5-year overall survival rates and number of patients for aggregate patient data, and types of treatment and outcomes for individual patient data. RESULTS The 5-year overall survival rate of 752 patients was 57%. In the individual patient data meta-analysis, the 5-year overall survival rates of patients who received surgery ± RT, preoperative CRT, definitive CRT, and postoperative CRT were 53.5%, 85.7%, 43.6%, and 0%, respectively. CONCLUSION Our data suggest that preoperative CRT may improve the survival of surgically treated patients with external auditory canal SCC and that definitive CRT may be equivalent to surgical resection.
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Affiliation(s)
- Yukinori Takenaka
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hironori Cho
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Susumu Nakahara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yoshifumi Yamamoto
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Toshimichi Yasui
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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Lionello M, Stritoni P, Facciolo M, Staffieri A, Martini A, Mazzoni A, Zanoletti E, Marioni G. Temporal bone carcinoma. Current diagnostic, therapeutic, and prognostic concepts. J Surg Oncol 2014; 110:383-92. [DOI: 10.1002/jso.23660] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/29/2014] [Indexed: 12/25/2022]
Affiliation(s)
- M. Lionello
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
| | - P. Stritoni
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
- Visiting Doctor at Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York, USA
| | - M.C. Facciolo
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
| | - A. Staffieri
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
| | - A. Martini
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
| | - A. Mazzoni
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
| | - E. Zanoletti
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
| | - G. Marioni
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
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Jia X, Liang Q, Chi F. Treatment and outcome of middle ear cancer. Eur Arch Otorhinolaryngol 2013; 271:2675-80. [DOI: 10.1007/s00405-013-2728-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
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Zanoletti E, Marioni G, Stritoni P, Lionello M, Giacomelli L, Martini A, Mazzoni A. Temporal bone squamous cell carcinoma: Analyzing prognosis with univariate and multivariate models. Laryngoscope 2013; 124:1192-8. [DOI: 10.1002/lary.24400] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/17/2013] [Accepted: 08/21/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Elisabetta Zanoletti
- Department of Neurosciences; Otosurgery Unit, Padova General Hospital; Padova Italy
| | - Gino Marioni
- Department of Neurosciences; Otolaryngology Section; Padova Italy
| | | | - Marco Lionello
- Department of Neurosciences; Otolaryngology Section; Padova Italy
| | | | - Alessandro Martini
- Department of Neurosciences; Otosurgery Unit, Padova General Hospital; Padova Italy
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Ouaz K, Robier A, Lescanne E, Bobillier C, Morinière S, Bakhos D. Cancer of the external auditory canal. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:175-82. [PMID: 23845289 DOI: 10.1016/j.anorl.2012.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/16/2012] [Accepted: 08/24/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cancer of the external auditory canal is a rare tumour with an annual incidence of one per one million inhabitants. The objective of this study was to evaluate the 5-year overall survival and disease-free survival rates in a series of patients with carcinoma of the external auditory canal and to compare our results concerning the clinical presentation, management and survival with those of the literature. PATIENTS AND METHOD Ten patients were included in this retrospective, single-centre study over a 20-year period. Data concerning age, symptoms, imaging, TNM stage according to the Pittsburgh classification, histology, management, sequelae, recurrences and survival were recorded. RESULTS The mean age of the patients of this series was 60.7 years. Seven patients had a squamous cell carcinoma. The other histological types were undifferentiated carcinoma, adenoid cystic carcinoma and neuroendocrine carcinoma. Staging was based on the Pittsburgh classification with one stage I, one stage III and eight stage IV tumours. Five-year overall survival rates were 100%, 50% and 0%, respectively. The mean 5-year overall survival rate was 35% and the mean 5-year disease-free survival rate was 24%. CONCLUSION Carcinoma of the external auditory canal is a difficult diagnosis when the tumour does not present as a fungating mass protruding from the external auditory canal. The Pittsburgh classification was used for TNM staging of these tumours, allowing comparison of our results with those of the literature. The clinical findings and survival rates observed in this study are comparable to those reported in the literature. These tumours are associated with a poor prognosis on the basis of our results and published data.
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Affiliation(s)
- K Ouaz
- Service d'ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnellé, 37044 Tours, France
| | - A Robier
- Service d'ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine, université François-Rabelais, 37000 Tours, France
| | - E Lescanne
- Service d'ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine, université François-Rabelais, 37000 Tours, France
| | - C Bobillier
- Service d'ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnellé, 37044 Tours, France
| | - S Morinière
- Service d'ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine, université François-Rabelais, 37000 Tours, France
| | - D Bakhos
- Service d'ORL et chirurgie cervico-faciale, CHRU de Tours, boulevard Tonnellé, 37044 Tours, France; Faculté de médecine, université François-Rabelais, 37000 Tours, France.
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Visnyei K, Gill R, Azizi E, Culliney B. Squamous cell carcinoma of the external auditory canal: A case report and review of the literature. Oncol Lett 2013; 5:1587-1590. [PMID: 23761823 PMCID: PMC3678866 DOI: 10.3892/ol.2013.1241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 11/30/2012] [Indexed: 11/25/2022] Open
Abstract
Squamous cell carcinoma of the external auditory canal, middle ear and temporal bone is a rare and unusual malignancy. The lack of a unifying classification system in the past, along with the rarity of the disease has made the development of clear treatment guidelines difficult. In this report, we describe a clinical case of a patient with this rare malignancy, discuss the challenges associated with the diagnosis and treatment of the disease, and review the literature for trends while outlining the most beneficial treatment strategy for this patient population.
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Affiliation(s)
- Koppany Visnyei
- Departments of Internal Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY 1003, USA
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Abstract
Primary temporal bone tumors are rare. Suspicious lesions of the ear canal should be biopsied for diagnosis. Surgical resection to achieve negative margins is the mainstay of treatment. Small tumors can be treated with lateral temporal bone resection. Parotidectomy and neck dissection are added for disease extension and proper staging. Higher staged tumors generally require subtotal temporal bone resection or total temporal bone resection. Adjuvant postoperative radiotherapy has shown improved survival for some patients. Chemotherapy has an emerging role for advanced stage disease. Evaluation and management by a multidisciplinary team are the best approach for patients with these tumors.
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Affiliation(s)
- Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Postoperative Intensity-Modulated Radiotherapy for Squamous Cell Carcinoma of the External Auditory Canal and Middle Ear: Treatment Outcomes, Marginal Misses, and Perspective on Target Delineation. Int J Radiat Oncol Biol Phys 2012; 82:1485-93. [DOI: 10.1016/j.ijrobp.2011.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/25/2011] [Accepted: 05/05/2011] [Indexed: 11/20/2022]
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