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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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2
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Mohammed R, Youssef R, Soufiyane K, Omar O, Mohamed C, Youssef L, Othmane B, Abdelaziz R. Comparison Between the Superior Pedicle Retro Auricular Flap and the Masson's Revolving Door Flap for Coverage of Conchal Defects. Indian J Otolaryngol Head Neck Surg 2024; 76:2442-2448. [PMID: 38883533 PMCID: PMC11169423 DOI: 10.1007/s12070-024-04497-y] [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: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 06/18/2024] Open
Abstract
Post operative defect of the external ear result mainly from the resection of skin cancers of this region, hence the need for an adequate plasty to avoid any stenosis or deformation, this article compares 2 retroauricular flap covering techniques through 2 cases of patients with conchal basal cell carcinoma the first one was a 65 years old male patient who had for 2 years a basal cell carcinoma of the postero-superior part of the concha of the right ear, a total removal of the tumor was made with a successful covering of the substance loss by a retroauricular flap with superior pedicle. The second patient was a 66 years old female who has for 3 years a basal cell carcinoma of the inferior part of the concha of the right ear, a successful removal of the tumor was and the covering of the substance loss by a Masson's retroauricular revolving door flap. We discuss the different operating times as well as the advantages and disadvantages of each technique, to finally conclude that the retro auricular flap is an excellent technique to cover the postoperative loss of substance of the superior part whereas the Masson's revolving door flap is more adapted for the posterior lesions of the concha.
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Affiliation(s)
- Rami Mohammed
- Mohammed VI University Hospital of Marrakech, Ear Nose and Throat, Head And Neck Surgery Department, Marrakech, Morocco
| | - Rochdi Youssef
- Mohammed VI University Hospital of Marrakech, Ear Nose and Throat, Head And Neck Surgery Department, Marrakech, Morocco
| | - Kajai Soufiyane
- Mohammed VI University Hospital of Marrakech, Ear Nose and Throat, Head And Neck Surgery Department, Marrakech, Morocco
| | - Oulghoul Omar
- Mohammed VI University Hospital of Marrakech, Ear Nose and Throat, Head And Neck Surgery Department, Marrakech, Morocco
| | - Chahbouni Mohamed
- Mohammed VI University Hospital of Marrakech, Ear Nose and Throat, Head And Neck Surgery Department, Marrakech, Morocco
| | - Lakhdar Youssef
- Mohammed VI University Hospital of Marrakech, Ear Nose and Throat, Head And Neck Surgery Department, Marrakech, Morocco
| | - Benhoummad Othmane
- Mohammed VI University Hospital of Marrakech, Ear Nose and Throat, Head And Neck Surgery Department, Marrakech, Morocco
| | - Raji Abdelaziz
- Mohammed VI University Hospital of Marrakech, Ear Nose and Throat, Head And Neck Surgery Department, Marrakech, Morocco
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3
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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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Hamberis AO, Gidumal S, Fan CJ, Khorsandi A, Schwam ZG, Wanna GB. A Case of HPV+ Squamous Cell Carcinoma of the Perigeniculate Area and Middle Fossa. Laryngoscope 2023; 133:3158-3160. [PMID: 36971232 DOI: 10.1002/lary.30661] [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: 04/01/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 10/19/2023]
Abstract
Herein we present an unusual case of a primary HPV+ perigeniculate, extra-axial middle fossa skull base tumor and our management thereof. Laryngoscope, 133:3158-3160, 2023.
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Affiliation(s)
- Alexandra O Hamberis
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Sunder Gidumal
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Caleb J Fan
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Azita Khorsandi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Zachary G Schwam
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - George B Wanna
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Plath M, Plinkert PK. [Medical examination: Preparation for ENT specialisation : Part 66]. HNO 2023:10.1007/s00106-023-01297-8. [PMID: 37072504 DOI: 10.1007/s00106-023-01297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 04/20/2023]
Affiliation(s)
- M Plath
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - P K Plinkert
- Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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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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Long-term analysis of prognostic risk factors impacting surgical outcomes in patients with external auditory canal carcinoma. Eur Arch Otorhinolaryngol 2023; 280:2965-2974. [PMID: 36806747 DOI: 10.1007/s00405-023-07890-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Malignant neoplasms of the external auditory canal (EAC) are rare. No consensus on management has emerged. OBJECTIVE To determine possible risk factors influencing tumorgenesis and prognosis of EAC carcinoma. MATERIALS AND METHODS 108 patients (87 men/21 women) with an average age of 74 ± 13.8 years were recruited from 2005 to 2019 at Department of Otorhinolaryngology, Head and Neck Surgery Heidelberg. The follow-up interval was 43.62 ± 55.39 months. Partial and (sub)total ablative otis, supplementary surgery (petrosectomy, parotidectomy, neck dissection, mastoidectomy) and adjuvant radio(chemo)therapy belonged to treatment options. TNM status was determined at time of diagnosis using the AJCC staging system. RESULTS 63.9% of patients underwent a total ablative otis. Tumor recurrence was seen in 24.1%. The 1-year survival rate was 87%, the 5-year survival rate was 52%, the mean overall survival (OS) was 3.82 ± 4.6 years. Male EAC carcinoma patients had a better OS (p < 0.001), PFS (p < 0.001) and DSS (p = 0.02) than females. T1 patients had a better OS (p = 0.01), PFS (p = 0.01) and DSS (p < 0.001) than T4 patients. Lymph node but not distant metastasis, tumor grading, perineural, venous and lymphatic invasion, histology, age and tumor localization influenced the OS in EAC carcinoma patients (p = 0.04). The more radical the ablative otis, the worse the OS (p = 0.002), PFS (p = 0.02) and DSS (p < 0.001). Radio(chemo)therapy did not improve the OS. CONCLUSIONS EAC carcinoma are difficult to treat and benefit from early diagnosis so that a radical combined treatment approach does not need to be used.
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8
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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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9
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Hintze JM, O'Riordan I, Jones H, McHugh A, Gendre A, Timon C, Kinsella J, Lennon P, Walsh RM, Shine N, O'Neill JP. Pattern of nodal metastasis of cutaneous squamous cell carcinoma involving the temporal bone. Laryngoscope Investig Otolaryngol 2022; 8:120-124. [PMID: 36846411 PMCID: PMC9948558 DOI: 10.1002/lio2.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/31/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The objective of this study was to explore the pattern of lymph-node spread of SCCs involving the temporal bone. Methods We retrospectively reviewed all cutaneous SCCs involving the temporal bone over a 20-year time-period. Forty-one patients were eligible. Results Mean age was 72.8 years. The diagnosis was cutaneous SCC in all cases.All patients underwent a temporal bone resection, 70.7% had a neck-dissection and 78.0% a parotidectomy.Level 2 was the most common area of neck metastasis, and occurred in 12.2%. The parotid had disease in 34.1%. 51.2% of patients underwent free-flap reconstruction.Mean overall survival of the cohort was 4.2 years. Conclusions Overall, the rate of cervical nodal metastasis was 22.0% and 13.5% in the occult setting. The parotid was involved in 34.1% and 10.0% in the occult setting. Results from the present study support consideration for performing a parotidectomy at the time of temporal bone resection, while a neck dissection can be performed for adequate staging of the nodal basin. Level of Evidence 3.
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Affiliation(s)
- Justin M. Hintze
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland,Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - Isobel O'Riordan
- Royal College of Surgeons in IrelandDublinIreland,Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - Holly Jones
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - Alison McHugh
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - Adrien Gendre
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - Conrad Timon
- Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - John Kinsella
- Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - Paul Lennon
- Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - Rory McConn Walsh
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - Neville Shine
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - James P. O'Neill
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
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10
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Gore MR. Treatment, Survival, and Demographics in Temporal Bone Malignancies: A Pooled Data Analysis. Cureus 2022; 14:e31973. [DOI: 10.7759/cureus.31973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
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Shen YW, Yang Y, Liu H, Zhou ZJ, Li T. Metastatic Ceruminous Adenoid Cystic Carcinoma of the Lumbar Spine Causing Neurological Compromise: A Case Report. Geriatr Orthop Surg Rehabil 2022; 13:21514593221111357. [PMID: 35859790 PMCID: PMC9290092 DOI: 10.1177/21514593221111357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/16/2022] [Indexed: 02/05/2023] Open
Abstract
Background Ceruminous glands are modified apocrine glands of the external auditory canal (EAC). Malignant tumours within the ceruminous glands are extremely rare, and the most common histological type is adenoid cystic carcinoma (ADCC), which has high recurrence and metastasis risks. Although a few cases of metastatic ADCC from other head and neck glands have been reported, metastatic ADCC originating from the ceruminous gland are extremely rare. Case presentation We present an unusual case of spinal metastases of ADCC from ceruminous glands. A 61-year-old woman complaining of low back pain and both lower limbs pain was referred to our department. The primary ceruminous tumour was resected 26 years ago and recurred 6 years later, which was treated by radiotherapy. Three years ago, she presented with low back pain and was diagnosed as multiple lungs and bone metastases. The patient underwent tumour excision, decompression and fusion. The biopsy revealed metastatic ADCC. The symptoms were alleviated after surgery. Conclusions ADCC of EAC is a pernicious malignant tumour that is characterized by slow-growing patterns and a high predisposition to recurrence and metastasis. Differential diagnoses of ADCC and benign tumours in the EAC are challenging, particularly at early stages. We report a rare case of ceruminous ADCC with a prolonged clinical history as well as spinal metastasis and highlight the significance of regular follow-ups for patients undergoing tumour excision in the EAC.
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Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong-Jie Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Ando Y, Morita S, Shimokata T, Tsuzuki T, Inafuku S, Iwami K, Brega N, Akagawa T, Tsujino T, Ogawa T. A rapid and durable response to larotrectinib in a patient with NTRK fusion-positive secretory carcinoma originating from the external auditory canal. Int Cancer Conf J 2022; 11:242-246. [PMID: 36186229 PMCID: PMC9522948 DOI: 10.1007/s13691-022-00559-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/27/2022] [Indexed: 01/14/2023] Open
Abstract
For decades, no clear consensus existed on the standard treatment option for malignant tumors of the external auditory canal, an extremely rare disease. Here we report the case of a 55-year-old female patient with secretory carcinoma that originated from the left external auditory canal. Magnetic resonance imaging (MRI) at baseline showed that the tumor had extended to the medulla oblongata despite surgical and radiation treatments for more than 20 years from the initial diagnosis. Based on the results of a next-generation sequencing test of a formalin-fixed paraffin-embedded surgical specimen indicating that the tumor harbored ETV6–NTRK3 fusion, the patient was enrolled in a global basket study of larotrectinib, an oral selective tropomyosin receptor kinase (TRK) inhibitor. Three weeks after the start of larotrectinib treatment, MRI showed only small remnants of the tumor in the medulla oblongata and the patient’s headache before the treatment had disappeared. Subsequent MRI after 12 weeks of treatment confirmed the complete disappearance of the tumor. The patient repeated grade 2 flu-like symptoms related to treatment, but did not experience any other grade 2 or worse treatment-related adverse events. TRK inhibitors, such as larotrectinib, exert potent antitumor activity against neurotrophic tyrosine receptor kinase (NTRK) fusion-positive tumors in a tumor-agnostic manner. To the best of our knowledge, this is the first report on NTRK fusion-positive secretory carcinoma of the external auditory canal, and this report provides a valuable insight into the management of the extremely rare but now treatable malignancy.
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Affiliation(s)
- Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Sachi Morita
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Tomoya Shimokata
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Shigeru Inafuku
- Department of Otorhinolaryngology-Head and Neck Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Kenichiro Iwami
- Departments of Neurosurgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Nicoletta Brega
- Bayer Pharmaceuticals, Viale Certosa 130, 20156 Milan, Italy
| | - Takashi Akagawa
- Bayer Yakuhin, Ltd., Breeze Tower, 2-4-9, Umeda, Kita-ku, Osaka, 530-0001 Japan
| | - Toshiaki Tsujino
- Bayer Yakuhin, Ltd., Breeze Tower, 2-4-9, Umeda, Kita-ku, Osaka, 530-0001 Japan
| | - Tetsuya Ogawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
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13
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Goto S, Nishio N, Iwami K, Yoshida T, Maruo T, Mukoyama N, Tsuzuki H, Yokoi S, Wada A, Hiramatsu M, Hayashi Y, Kamei Y, Fujii M, Sone M, Fujimoto Y. Surgical Strategy for Squamous Cell Carcinoma of the External Auditory Canal: Management of Locally Advanced Cases with Skull Base Involvement. J Neurol Surg B Skull Base 2022; 84:69-78. [PMID: 36743718 PMCID: PMC9897898 DOI: 10.1055/a-1733-2585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/04/2022] [Indexed: 02/07/2023] Open
Abstract
Objective Surgical indications for advanced-stage squamous cell carcinoma (SCC) of the external auditory canal (EAC) are highly dependent on the skull base surgery team. The aim of this study was to evaluate the surgical outcomes in patients with SCC of the EAC and to clarify the surgical indication of far advanced cases using the T4 subclassification. Methods Patients with SCC of the EAC who underwent curative treatment from 2002 to 2021 at our hospital were retrospectively reviewed. Clinical and surgical results, including operative data, overall survival (OS), and disease-specific survival (DSS), were analyzed. To clarify the surgical indication for advanced-stage tumors, we proposed the T4 subclassification. Results In the 46 patients included in the study, 8 patients had T1 tumors, 10 had T2 tumor, 5 had T3 tumors, and 23 had T4 tumors. The 5-year DSS with T1, T2, T3, and T4 tumors were 100, 85.7, 100, and 61.7%, respectively. No prognostic impacts for margin status were found between the 5-year OS and DSS ( p = 0.23 and 0.13, respectively). Patients with far-advanced-stage (T4b) tumors were significantly associated with shorter DSS than those with early-stage (T1/T2) and advanced-stage (T3/T4a) tumors ( p = 0.007 and 0.03, respectively). Conclusion The present study focused on patients with SCC of the EAC at a university hospital over a period of 20 years, especially with skull base involvement, and a T4 subclassification was proposed. Complete tumor resection in an en bloc fashion could help achieve a good survival rate even in patients with locally advanced tumors.
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Affiliation(s)
- Seiya Goto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan,Address for correspondence Naoki Nishio, MD, PhD Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine65, Tsurumai-cho, Showa-ku, Nagoya 466-8550Japan
| | - Kenichiro Iwami
- Department of Neurosurgery, Aichi Medical University, Aichi, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sayaka Yokoi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Wada
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichiro Hayashi
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masazumi Fujii
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan,Department of Otorhinolaryngology, Head and Neck Surgery, Aichi Medical University, Aichi, Japan
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14
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Leedman S, Wormald R, Flukes S. Lateral temporal bone resection for cutaneous carcinomas of the external auditory canal and peri-auricular region. J Laryngol Otol 2021; 135:1-6. [PMID: 34583793 DOI: 10.1017/s0022215121002607] [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: 12/30/2022]
Abstract
OBJECTIVES To evaluate the outcomes for patients after lateral temporal bone resection surgery for cutaneous squamous cell carcinoma and basal cell carcinoma, and to ascertain predictors of survival and treatment failure. METHODS A retrospective review was conducted of the medical records for all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma or basal cell carcinoma between 2007 and 2019 in Western Australia. RESULTS Thirty-seven patients underwent lateral temporal bone resection surgery. Median follow-up duration was 22 months. Twenty-five patients had squamous cell carcinoma and 12 had basal cell carcinoma. The overall survival rate at two years for patients with squamous cell carcinoma was 68.5 per cent. Pre-operative facial nerve involvement (determined via clinical or radiological evidence) was identified as a predictor of mortality (hazard ratio = 3.411, p = 0.006), with all patients dying before two years post-operatively. Locoregional tumour control was achieved in 81 per cent of cases (n = 30). CONCLUSION Lateral temporal bone resection offers acceptable local control rates and survival outcomes. Caution should be used in offering this surgery to patients with clinical or radiological evidence of facial nerve involvement because of the relatively poorer survival outcomes in this subgroup.
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Affiliation(s)
- S Leedman
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
| | - R Wormald
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
| | - S Flukes
- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
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15
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The importance of flaps in reconstruction of locoregionally advanced lateral skull-base cancer defects: a tertiary otorhinolaryngology referral centre experience. Radiol Oncol 2021; 55:323-332. [PMID: 33735947 PMCID: PMC8366724 DOI: 10.2478/raon-2021-0012] [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: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The aim of the study was to identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer. PATIENTS AND METHODS The retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre was made. RESULTS Twelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75.0%), partial parotidectomy in six (50.0%), total parotidectomy in one (8.3%), ipsilateral selective neck dissection in eight (66.7%) and ipsilateral modified radical neck dissection in one patient (8.3%). The defect was reconstructed with anterolateral thigh free flap, radial forearm free flap or pectoralis major myocutaneous flap in two patients (17.0%) each. Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100%. At the data collection cut-off, 83% of analysed patients and 100% of patients with flap reconstruction were alive. CONCLUSIONS Favourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.
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16
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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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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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18
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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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19
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Anazawa U, Omura K, Nishijima Y, Aoki K, Kojima H, Tanaka Y. External auditory canal reconstruction with inferior pedicled square screw flap from the preauricular area after resection of external auditory canal cancer. Laryngoscope Investig Otolaryngol 2021; 6:77-80. [PMID: 33614933 PMCID: PMC7883608 DOI: 10.1002/lio2.505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/11/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The postoperative reconstruction of ear canal cancer with a local flap such as the snail flap technique has been reported for cases with few tissue defects. The snail flap technique requires a large skin incision and is at risk of facial neuropathy. We have devised a new flap that addresses these problems. METHODS An 80-year-old woman underwent total right ear canal resection for cancer of the right ear canal, and the defect of the ear canal was reconstructed using a local flap. The local flap was used by making a rectangular incision in front of the auricle and rolling it into a cylindrical shape. We named this flap a square screw flap. RESULTS The patient was discharged 1 week after surgery without complications. CONCLUSIONS This method is considered to be useful for reconstruction of the ear canal with a small defect.
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Affiliation(s)
- Utaro Anazawa
- Department of OtolaryngologyDokkyo Medical University Saitama Medical CenterSaitamaJapan
| | - Kazuhiro Omura
- Department of OtorhinolaryngologyThe Jikei University School of MedicineTokyoJapan
| | - Yoshikata Nishijima
- Department of OtolaryngologyDokkyo Medical University Saitama Medical CenterSaitamaJapan
| | | | - Hiromi Kojima
- Department of OtorhinolaryngologyThe Jikei University School of MedicineTokyoJapan
| | - Yasuhiro Tanaka
- Department of OtolaryngologyDokkyo Medical University Saitama Medical CenterSaitamaJapan
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20
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Pandiar D, Aravind S, Nayanar SK, Babu S. Incipient Warthin tumor of intraparotid lymph node in a patient with squamous cell carcinoma of the external auditory canal: An incidental finding. Natl J Maxillofac Surg 2020; 11:113-116. [PMID: 33041588 PMCID: PMC7518491 DOI: 10.4103/njms.njms_46_18] [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: 06/04/2018] [Revised: 09/19/2019] [Accepted: 10/18/2019] [Indexed: 11/11/2022] Open
Abstract
The occurrence of intranodal salivary gland neoplasm is uncommon; squamous cell carcinoma (SCC) of the external auditory canal (EAC) is another rare occurrence. Clinically, SCC of EAC presents with symptoms similar to other benign otologic conditions. A case of Stage I SCC in EAC region is presented here in a 60-year-old male patient with incidental intranodal Warthin tumor along with the histological differential diagnosis. The patient is being followed up. There is no evidence of recurrence 1 year and 11 months after surgery.
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Affiliation(s)
- Deepak Pandiar
- Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Center, Thalassery, Kerala, India
| | - Sithara Aravind
- Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Center, Thalassery, Kerala, India
| | - Sangeetha K Nayanar
- Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Center, Thalassery, Kerala, India
| | - Sajith Babu
- Department of Surgical Oncology, Malabar Cancer Center, Thalassery, Kerala, India
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21
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Lechner M, Sutton L, Murkin C, Masterson L, O'Flynn P, Wareing MJ, Tatla T, Saeed S. Squamous cell cancer of the temporal bone: a review of the literature. Eur Arch Otorhinolaryngol 2020; 278:2225-2228. [PMID: 32869160 PMCID: PMC8165064 DOI: 10.1007/s00405-020-06281-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
Background and aims Squamous cell carcinoma (SCC) of the temporal bone is a rare malignancy accounting for only 0.2% of head and neck cancers. There is currently no clear consensus on staging or common approach to management. It is the aim of this work to provide the readers with a review of the current literature on this malignancy. Methods A literature review was performed identifying 16 case series with patient numbers ranging from 12 to 124. A total of 708 patients were included in this review, 67% presented with advanced disease. 578 cases were managed operatively with lateral temporal bone resection, some underwent local resection alone in early stage disease. In all studies radiation therapy was used as an adjunct to some degree. Results More than half of studies reported 100% either 2-, 3- or 5-year survival for T1 and T2 disease with no nodal involvement. Survival correlated with disease stage and in five studies SCC differentiation was found to be a significant prognostic factor. Post-operative radiotherapy was found to improve survival in only one study. Conclusions Temporal bone SCC is a readily treatable malignancy in early stage disease, however late stage disease has a poor prognosis. Differentiation of the SCC and stage of disease at presentation appear to have the greatest influence on 5-year survival rates. Further work is required in both the identification of early stage disease and in the treatment of later T3 and T4 lesions. Electronic supplementary material The online version of this article (10.1007/s00405-020-06281-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matt Lechner
- Royal London Hospital, Barts Health NHS Trust, London, UK. .,UCL Cancer Institute, University College London, 72 Huntley Street, London, WC1E 6DD, UK.
| | - Liam Sutton
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Paul O'Flynn
- Department of ENT, Adenbrooke's Hospital, Cambridge, UK.,Head and Neck Centre, University College London Hospitals NHS Trust, Euston Road, London, NW1 2PG, UK
| | | | - Taranjit Tatla
- Department of Otolaryngology-Head and Neck Surgery, Northwick Park Hospital, Harrow Road, Harrow, London, UK
| | - Shakeel Saeed
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, 330 Grays Inn Road, London, WC1X 8DA, UK.,UCL Ear Institute, 332 Gray's Inn Road, London, UK
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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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External auditory canal carcinoma: clinical characteristics and long-term treatment outcomes. Eur Arch Otorhinolaryngol 2020; 277:2709-2720. [PMID: 32367152 DOI: 10.1007/s00405-020-06019-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/26/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Evidence-based treatment recommendations for external auditory canal (EAC) carcinoma are lacking in available literature. This study aims to evaluate the clinical characteristics and long-term outcomes of EAC carcinoma in a tertiary referral centre in a period of 15 years and identify independent prognostic factors. METHODS Retrospective observational study enrolling all patients with primary EAC carcinoma who underwent primary surgical treatment at the Portuguese Institute of Oncology (Lisbon) between 2004 and 2018. Epidemiological, clinical, histopathological and surgical data were retrieved from clinical records and analysed. RESULTS Twenty-seven patients were identified, with a median age of 77 years (range 29-92 years) and a slight female predominance (59.3%). Squamous cell carcinoma (55.6%) was the most common histological type, followed by basal cell carcinoma (40.7%) and ceruminous adenocarcinoma (3.7%). Pittsburgh tumour staging was distributed as early stage in 51.9% (I: 40.7%; II: 11.1%) and advanced stage in 48.1% (III: 29.6%; IV: 18.5%). Median follow-up period was 21 months (interquartile-range: 47). Four patients (14.8%) showed recurrence; recurrence rate was significantly higher in individuals aged < 60 years (p = 0.025) and with lymphovascular invasion (p = 0.049). Median overall survival was 88 months and estimated 2-year and 5-year overall survival rates were both 66%. Survival rates were higher in early stage patients (p = 0.021) and in those without facial palsy (p = 0.032). CONCLUSION Based on the available evidence in this review, individuals aged < 60, facial nerve impairment, advanced stage lesions, presence of lymphovascular invasion and squamous cell carcinoma histology are all associated with poor outcome and may be considered when discussing optimal treatment strategies in patients with EAC carcinoma.
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Seligman KL, Sun DQ, Ten Eyck PP, Schularick NM, Hansen MR. Temporal bone carcinoma: Treatment patterns and survival. Laryngoscope 2019; 130:E11-E20. [PMID: 30874314 DOI: 10.1002/lary.27877] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/11/2019] [Accepted: 01/29/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS Carcinomas of the temporal bone are rare, and appropriate treatment, staging, and survival data are limited. This study evaluates clinical characteristics and survival rates for patients with temporal bone carcinoma treated with resection at a single tertiary-care institution, with a focus on the outcomes of patients with locally advanced disease including skull base and/or dural invasion. STUDY DESIGN Retrospective chart review. METHODS Demographic, tumor-specific, and survival data were collected for patients with primary carcinomas of the external auditory canal with involvement of the temporal bone from 2003 to 2015. All patients were staged according to the modified Pittsburgh system. Kaplan-Meier and logistic regression analysis were used to calculate factor-specific survival outcomes. RESULTS Sixty-seven patients met inclusion criteria; 85% were male. There were 43 squamous cell carcinomas (64%) and 24 basal cell carcinomas (BCCs) (36%). Tumor stage was 24 (36%) T2, 12 (18%) T3, and 31 (46%) T4 tumors; 53% had recurrent disease. Surgical management included 49 lateral temporal bone resections and 18 subtotal temporal bone resections. Kaplan-Meier analyses revealed more favorable 5-year survival rates associated with BCC histology (P = .01), lateral temporal bone resection compared to subtotal temporal bone resection (P < .01), lack of immunocompromise (P = .04), and absence of perineural/lymphovascular invasion (P = .01). Multivariate regression analysis did not yield statistically significant results. CONCLUSIONS Factors predictive of more favorable survival include lack of immunocompromise, BCC histology, absence of perineural/lymphovascular invasion, and disease extent amenable to lateral temporal bone resection. Dural invasion is not an absolute contraindication to surgery, with a subset of patients surviving >5 years. LEVEL OF EVIDENCE 3 Laryngoscope, 130:E11-E20, 2020.
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Affiliation(s)
- Kristen L Seligman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Daniel Q Sun
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa
| | - Patrick P Ten Eyck
- Institute of Clinical and Translational Sciences, University of Iowa, Iowa City, Iowa
| | - Nathan M Schularick
- Ear, Nose, and Throat SpecialtyCare of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa.,Institute of Clinical and Translational Sciences, University of Iowa, Iowa City, Iowa
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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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Nam GS, Moon IS, Kim JH, Kim SH, Choi JY, Son EJ. Prognostic Factors Affecting Surgical Outcomes in Squamous Cell Carcinoma of External Auditory Canal. Clin Exp Otorhinolaryngol 2018; 11:259-266. [PMID: 29779363 PMCID: PMC6222191 DOI: 10.21053/ceo.2017.01340] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/30/2018] [Indexed: 01/21/2023] Open
Abstract
Objectives Carcinomas of the external auditory canal (EAC) are rare, and management remains challenging. Previous studies seeking prognostic factors for EAC cancers included cancers other than carcinomas. In this study, we analyzed the treatment outcomes of, prognostic factors for, and survival rates associated with specifically squamous cell carcinoma (SCC) of the EAC. Methods A retrospective review of 26 consecutive patients diagnosed with SCCs of the EAC in a 10-year period was performed in terms of clinical presentation, stage, choice of surgical procedure, and adjunct therapy. Overall survival (OS) and recurrence-free survival (RFS) were calculated and univariate analysis of prognostic factors was performed. Results The median age of the 26 patients with SCCs of the EAC was 63 years (range, 40 to 72 years), and 16 males and 10 females were included. According to the modified University of Pittsburgh staging system, the T stages were T1 in 11, T2 in six, T3 in four, and T4 in five cases. The surgical procedures employed were wide excision in three cases, lateral temporal bone resection (LTBR) in 17, and extended LTBR in four, and subtotal temporal bone resection in two. Two patients underwent neoadjuvant chemotherapy, and two underwent adjuvant chemotherapy. One patient received preoperative radiation therapy, and eleven received postoperative radiation therapy. Of the possibly prognostic factors examined, advanced preoperative T stage and advanced overall stage were significant predictors of RFS, but not of OS. Conclusion The advanced T stage and overall stage were associated with decreased survival after surgical treatment in patients with SCC of the EAC, highlighting the importance of clinical vigilance and early detection.
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Affiliation(s)
- Gi-Sung Nam
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyung Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Huhn Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Son
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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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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Abstract
OBJECTIVE We aimed to evaluate the prognostic factors and efficacy of treatment modalities for patients with temporal bone cancer, and to determine if definitive chemoradiotherapy (CRT) for advanced-stage disease can provide a substitute for highly invasive surgeries. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS Sixty-six patients with previously untreated squamous cell carcinoma of the temporal bone treated with curative intent between April 1997 and March 2015. INTERVENTION Surgery alone, radiotherapy (RT) alone, surgery followed by RT or definitive CRT. MAIN OUTCOME MEASURE The overall survival (OS) rate. RESULTS The 5-year OS rate for each T classification was 100% for T1, 76.2% for T2, 55.6% for T3, and 36.7% for T4. Univariable and multivariable analysis showed that T classification was an independent predictor of the OS rate (hazard ratio 5.66; 95% confidence interval 1.51-27.0; p = 0.015). Analysis by treatment modality revealed that the 5-year OS rate for patients with T1-2 was 100% for surgery and 81.3% for RT alone. The rate for patients with T3-4 was 52.1% for definitive CRT and 55.6% for surgery followed by RT with or without chemotherapy. CONCLUSIONS Patients with T1-2 benefited from surgical intervention without significant morbidity or mortality. Our findings also suggested that definitive CRT might be appropriate as the first-line treatment for T3-4, especially in cases with unresectable tumors.
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Snietura M, Chelmecka-Wiktorczyk L, Pakulo S, Kopec A, Piglowski W, Drabik G, Kosowski B, Wyrobek L, Stanek-Widera A, Balwierz W. Vertically transmitted HPV-dependent squamous cell carcinoma of the external auditory canal. Strahlenther Onkol 2016; 193:156-161. [DOI: 10.1007/s00066-016-1047-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022]
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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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Mazón M, Pont E, Montesinos P, Carreres-Polo J, Más-Estellés F. Radiology of external ear: indications, normal anatomy, and pathological processes. RADIOLOGIA 2015; 58:189-98. [PMID: 26460217 DOI: 10.1016/j.rx.2015.08.003] [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: 05/17/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 10/22/2022]
Abstract
The external ear is accessible to direct examination; the clinical history and otoscopy are sufficient to diagnose and treat most diseases of the external ear. We aim to describe the normal anatomy of the external ear, specify the indications for imaging tests, and review the clinical and radiological manifestations of the most common diseases affecting the external ear. We classify these diseases according to their origin into congenital, inflammatory, infectious, or traumatic disease or benign bone tumors or malignant tumors. Imaging does not play an important role in diseases of the external ear, but in certain clinical scenarios it can be crucial for reaching a concrete diagnosis and establishing the best treatment. Computed tomography is the first-choice technique for most diseases. Magnetic resonance imaging complements computed tomography and makes it possible to differentiate among different tissue types and to evaluate the extension of disease accurately.
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Affiliation(s)
- M Mazón
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - E Pont
- Servicio de Otorrinolaringología, Hospital General de Onteniente, Valencia, España
| | - P Montesinos
- Servicio de Radiología, Hospital de La Ribera, Alzira, España
| | - J Carreres-Polo
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - F Más-Estellés
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, España
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Zainuddin N, Abdullah O. Squamous cell carcinoma of the external auditory canal in a patient with non-resolving ear discharge. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2015; 10:52-54. [PMID: 27099662 PMCID: PMC4826582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Discharging ear is a common symptom in the primary care and private general clinics. Most of the cases are treated with the antibiotic ear drops for otitis externa or otitis media. However, despite an adequate standard therapy, a malignant tumour can also be present with non-specific symptom such as ear discharge, especially in the case of persistent ear discharge. In this paper we have reported a case of an adult woman presented with non-resolving ear discharge who was treated repeatedly with antibiotic ear drop, which was later diagnosed as squamous cell carcinoma.
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Affiliation(s)
- N Zainuddin
- Nazli Zainuddin (Corresponding author) MMed (ORL) Health & Wellbeing (HW) Core, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - O Abdullah
- Othman bin Abdullah Department of Pathology, Hospital Sultan Abdul Halim, Kedah, Malaysia
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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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Mingkwansook V, Curtin HD, Kelly HR. CT Findings in the External Auditory Canal after Transcanal Surgery. AJNR Am J Neuroradiol 2015; 36:982-6. [PMID: 25634720 DOI: 10.3174/ajnr.a4226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/21/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Middle ear surgery is often performed through the external auditory canal, and the CT appearance of the external auditory canal after transcanal middle ear surgery can mimic erosive pathology such as carcinoma, external auditory canal cholesteatoma, or necrotizing external otitis. We reviewed the CT findings in a group of patients following transcanal surgery to highlight this potential pitfall in interpretation. MATERIALS AND METHODS Twenty-seven temporal bones in 25 patients with a history of a transcanal approach to the middle ear and available postoperative CT imaging were identified. Images were assessed for changes along or involving the walls of the external auditory canal, including widening, irregularity, bony defects, and soft tissue opacification. RESULTS Osseous changes along the floor of the external auditory canal were demonstrated in 25 of 27 (92.6%) temporal bone CT scans. Similar changes were present in the superior and anterior walls of the external auditory canal in 21 and 18 temporal bones, respectively. The anterior wall was the most common site for complete bony defects (10 of 27 temporal bones). The posterior wall was the least often involved, with osseous changes in 15 of 27 temporal bones and bony defects in 3 cases. Soft tissue thickening was seen most commonly along the floor. No patient was found to have a superimposed pathologic process of the external auditory canal. CONCLUSIONS CT findings in the external auditory canal after transcanal surgery include thinning, irregularity and/or flattening of the bone, soft tissue thickening, and bony wall defects. Although these changes may be subtle, they may mimic pathology and should be included in the differential diagnosis of osseous abnormality of the external auditory canal.
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Affiliation(s)
- V Mingkwansook
- From the Radiology Department (V.M.), Thammasat University Hospital, Pathumthani, Thailand Department of Radiology (V.M., H.D.C., H.R.K.), Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston, Massachusetts
| | - H D Curtin
- Department of Radiology (V.M., H.D.C., H.R.K.), Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston, Massachusetts
| | - H R Kelly
- Department of Radiology (V.M., H.D.C., H.R.K.), Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston, Massachusetts Division of Neuroradiology (H.R.K.), Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
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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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39
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Chang HY, Jiang H, Zhou F. A rare case of metachronous triple cancers involving the tympanic membrane. Pak J Med Sci 2013; 29:218-9. [PMID: 24353544 PMCID: PMC3809166 DOI: 10.12669/pjms.291.2490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 11/21/2012] [Indexed: 12/12/2022] Open
Abstract
Multiple primary malignancies are not rare. While metachronous triple cancers are rare and a triple tumor case involving maxillary sinus and tympanic membrane is exceptionally rare. We present such an extremely rare case with the index tumor of adenoid cystic carcinoma of the maxillary sinus and 14 years later esophageal cancer was observed as a metachronous tumor. One year after esophageal cancer, squamous cell carcinoma arising from tympanic membrane was detected. Before the tumor of tympanic membrane was observed, the patient had received total three radiation courses. Prior radiation therapy is suspected to be playing a role in inducing the squamous cell carcinoma of the tympanic membrane.
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Affiliation(s)
- Hui-Yu Chang
- Hui-Yu Chang, MD, Department of Otolaryngology, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Hua Jiang
- Hua Jiang, MD, PhD, Department of Otolaryngology, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Fang Zhou
- Fang Zhou, MD, Department of Pathology, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
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40
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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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41
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Marioni G, Zanoletti E, Stritoni P, Lionello M, Giacomelli L, Gianatti A, Cattaneo L, Blandamura S, Mazzoni A, Martini A. Expression of the tumour-suppressor maspin in temporal bone carcinoma. Histopathology 2013; 63:242-9. [PMID: 23730906 DOI: 10.1111/his.12151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/26/2013] [Indexed: 02/06/2023]
Abstract
AIMS Although it accounts for fewer than 0.2% of all head and neck tumours, temporal bone squamous cell carcinoma (SCC) is an aggressive malignancy with a poor prognosis in advanced cases. Novel therapeutic strategies should be developed focusing on specific targeted therapies. Maspin is a serpin showing tumour-suppressing activity which has therapeutic potential. The present study is the first to investigate maspin expression in temporal bone SCCs, using a series of 29 cases. METHODS AND RESULTS Cytoplasmic maspin expression was significantly higher in the group of patients whose SCC did not recur than in the group experiencing recurrences (P = 0.029), and in G1-G2 SCCs than in G3 cases (P = 0.001). cT correlated with recurrence rate (P = 0.05), disease-free survival (DFS) (P = 0.008) and disease-specific survival (DSS) (P = 0.0043), and pT and pathological regional lymph node status correlated with recurrence rate (P = 0.008 and P = 0.03, respectively), DFS (P = 0.017 and P = 0.0049, respectively) and DSS (P = 0.008 and P = 0.0009, respectively). CONCLUSIONS Although further studies using larger series are required, our preliminary findings suggest that cytoplasmic maspin expression has promise as a prognostic indicator of disease recurrence in temporal bone SCC, and that reactivating maspin functions in association with apoptosis-inducing or anti-angiogenic chemotherapeutic agents might be an important goal in the treatment of temporal bone SCC.
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Affiliation(s)
- Gino Marioni
- Otolaryngology Section, Department of Neurosciences, Padova University, Padova, Italy.
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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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43
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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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44
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Essig GF, Kitipornchai L, Adams F, Zarate D, Gandhi M, Porceddu S, Panizza B. Lateral temporal bone resection in advanced cutaneous squamous cell carcinoma: report of 35 patients. J Neurol Surg B Skull Base 2012; 74:54-9. [PMID: 24436889 DOI: 10.1055/s-0032-1331021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/03/2012] [Indexed: 01/07/2023] Open
Abstract
Objective To evaluate lateral temporal bone resection (LTBR) in the management of advanced cutaneous squamous cell carcinoma (SCC) with temporal bone invasion and patterns of failure. Methods This is a retrospective study of 35 patients undergoing lateral temporal bone resection for advanced cutaneous SCC at a tertiary care center between 1995 and 2006. Results The Pittsburgh tumor stage was T4 in 18 patients (51%), T3 in 5 (14%), T2 in 9 (26%), and T1 in 3 (9%). Clear margins were reported in 22 (63%) patients. Resection of the mandible and/or temporomandibular joint (TMJ) was required in 11 (31%) patients. Facial nerve involvement was seen in 10 (29%) patients. Survival outcomes at 2 and 5 years for overall survival were 72% and 49%; disease-free survival, 68% and 59%; and disease-specific survival, 79% and 62%, respectively. Pittsburgh T stage correlated significantly with disease-specific survival (p = 0.015) and margin status was significant for both disease-free survival (p = 0.0015) and disease-specific survival (p < 0.001). Conclusions Surgery with curative intent is justified for cutaneous SCC invading the temporal bone with extended LTBR. Margin status was a significant predictor of outcome. Surgeons should plan preoperatively to achieve clear margins by extending the LTBR with possible nerve resection.
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Affiliation(s)
- Garth F Essig
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, United States
| | - Leon Kitipornchai
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Felicity Adams
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Dannie Zarate
- Queensland Cancer Control Analysis Team, Brisbane, Queensland, Australia
| | - Mitesh Gandhi
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sandro Porceddu
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia ; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Benedict Panizza
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia ; School of Medicine, University of Queensland, Brisbane, Queensland, Australia ; Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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45
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Squamous cell carcinoma of the external auditory canal: a case report. Case Rep Otolaryngol 2011; 2011:615210. [PMID: 22937370 PMCID: PMC3420775 DOI: 10.1155/2011/615210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 08/16/2011] [Indexed: 11/17/2022] Open
Abstract
Squamous cell carcinoma of the temporal bone and external auditory canal is a rare tumor with a reported incidence of between 1 to 6 cases per million population per year. Because squamous cell carcinoma of the temporal bone and auditory canal is so rare, developing an adequate tumor staging system and treatment has been difficult. We present a case of squamous cell carcinoma of the external auditory canal in 65-year-old Hispanic female who presented with a 6-month history of right ear pain, 3-month history of serosanguineous right ear drainage, and symptoms of facial paralysis. Due to the extensive spread of her tumor into the middle ear at the time of diagnosis, her tumor was deemed unresectable and she received palliative chemotherapy and radiation therapy and was sent to Alice Hospice and died several weeks later.
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Morris LGT, Mehra S, Shah JP, Bilsky MH, Selesnick SH, Kraus DH. Predictors of survival and recurrence after temporal bone resection for cancer. Head Neck 2011; 34:1231-9. [PMID: 21953902 DOI: 10.1002/hed.21883] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 05/22/2011] [Accepted: 06/27/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify factors predictive of outcome in patients undergoing temporal bone resection (TBR) for head and neck cancer. METHODS This was a retrospective study of 72 patients undergoing TBR. Factors associated with survival and recurrence were identified on multivariable regression. RESULTS Most tumors were epithelial (81%), commonly (69%) involving critical structures. Cervical metastases were uncommon (6%). Squamous cell carcinoma (SCC) of the external auditory canal carried a high rate of parotid invasion (25%) and parotid nodal metastases (43%). The 5-year rate of overall survival (OS) was 62%; disease-specific survival (DSS), 70%; recurrence-free survival (RFS), 46%. Factors independently associated with outcome on multivariable analysis were margin status and extratemporal spread of disease to the parotid, mandible, or regional nodes. Recurrence was common (72%) in cT3-4 tumors. CONCLUSIONS Margin status and extratemporal disease spread are the strongest independent predictors of survival and recurrence. In SCC of the external auditory canal, high rates of parotid involvement support adjunctive parotidectomy. Risk of recurrence in T3-T4 tumors may support a role for adjuvant therapy.
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Affiliation(s)
- Luc G T Morris
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Vorwerk H, Hess CF. Guidelines for delineation of lymphatic clinical target volumes for high conformal radiotherapy: head and neck region. Radiat Oncol 2011; 6:97. [PMID: 21854585 PMCID: PMC3178490 DOI: 10.1186/1748-717x-6-97] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 08/19/2011] [Indexed: 11/18/2022] Open
Abstract
The success of radiotherapy depends on the accurate delineation of the clinical target volume. The delineation of the lymph node regions has most impact, especially for tumors in the head and neck region. The purpose of this article was the development an atlas for the delineation of the clinical target volume for patients, who should receive radiotherapy for a tumor of the head and neck region. Literature was reviewed for localisations of the adjacent lymph node regions and their lymph drain in dependence of the tumor entity. On this basis the lymph node regions were contoured on transversal CT slices. The probability for involvement was reviewed and a recommendation for the delineation of the CTV was generated.
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Affiliation(s)
- Hilke Vorwerk
- Radiotherapy and Radiooncology, University Hospital Göttingen, Robert-Koch-Str, 40, 37073 Göttingen, Germany.
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48
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The role of facial palsy in staging squamous cell carcinoma of the temporal bone and external auditory canal: a comparative survival analysis. Otol Neurotol 2011; 31:1473-9. [PMID: 20930655 DOI: 10.1097/mao.0b013e3181f7ab85] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The role for facial palsy in the Pittsburgh staging system for squamous cell carcinoma (SCC) of the external auditory canal (EAC) is unclear. The objective of this study was to conduct a systematic review of published studies to determine the impact of facial palsy on survival outcomes. DATA SOURCES A search of MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, Cochrane, clinicaltrials.gov, and the National Guideline Clearinghouse databases was supplemented by hand searching. STUDY SELECTION Articles selected for final analysis had individual subject data on staging and/or facial nerve function, outcome, and follow-up period. DATA EXTRACTION Data extracted included demographics, type and stage of cancer, survival, and facial nerve status. DATA SYNTHESIS Of 3,046 citations identified by a systematic literature search, 21 case series including 348 subjects with SCC of the EAC met criteria for analysis. The overall and disease-specific survival for subjects with facial palsy were significantly worse than subjects without facial palsy, regardless of stage (p = 0.006 and p = 0.002, respectively). The overall survival outcome for subjects with facial palsy was significantly worse than subjects with stage PITT-2000 T3-designated cancer (p = 0.027) and demonstrated no statistically significant difference from stage PITT-2000 T4-designated cancer (p = 0.897). CONCLUSION This pooled-data survival analysis for SCC of the EAC demonstrates that facial nerve involvement is associated with a poor outcome and that the survival outcomes for subjects with facial palsy more closely parallel the survival curves of advanced stage T4 disease. Disease with facial palsy should be classified as stage T4, in accordance with the PITT-2000 system.
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49
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Dean NR, White HN, Carter DS, Desmond RA, Carroll WR, McGrew BM, Rosenthal EL. Outcomes following temporal bone resection. Laryngoscope 2010; 120:1516-22. [PMID: 20641083 DOI: 10.1002/lary.20999] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate survival outcomes in patients undergoing temporal bone resection. STUDY DESIGN Retrospective review. METHODS From 2002 to 2009 a total of 65 patients underwent temporal bone resection for epithelial (n = 47) and salivary (n = 18) skull base malignancies. Tumor characteristics, defect reconstruction, and postoperative course were assessed. Outcomes measured included disease-free survival and cancer recurrence. RESULTS The majority of patients presented with recurrent (65%), advanced stage (94%), cutaneous (72%), and squamous cell carcinoma (57%). Thirty-nine patients had perineural invasion (60%) and required facial nerve resection; 16 (25%) had intracranial extension. Local (n = 6), regional (n = 2), or free flap (n = 46) reconstruction was required in 80% of patients. Free flap donor sites included the anterolateral thigh (31%), radial forearm free flap (19%), rectus (35%), and latissimus (4%). The average hospital stay was 4.9 days (range, 1-28 days). The overall complication rate was 15% and included stroke (n = 4), cerebrospinal fluid leak (n = 2), hematoma formation (n = 1), infection (n = 1), flap loss (n = 1), and postoperative myocardial infarction (n = 1). A total of 22 patients (34%) developed cancer recurrence during the follow-up period (median, 10 months), 17 (77%) of whom presented with recurrent disease at the time of temporal bone resection. Two-year disease-free survival was 68%, and 5-year disease-free survival was 50%. CONCLUSIONS Aggressive surgical resection and reconstruction is recommended for primary and recurrent skull base malignancies with acceptable morbidity and improved disease-free survival.
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Affiliation(s)
- Nichole R Dean
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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50
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Fleiner F, Jumah M, Göktas O. Cancer of the external auditory canal-diagnostic and treatment. Indian J Otolaryngol Head Neck Surg 2010; 61:270-4. [PMID: 23120649 DOI: 10.1007/s12070-009-0081-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ear squamous cell carcinoma (SCC) is a tumor with a poor prognosis, due to a late initial diagnosis because of a concealment by primarily benign symptoms and due to the unfavorable localization including the infiltration of important structures such as the middle ear, mandibular joint or dura. PATIENTS AND METHODS We retrospectively examined 10 patients, medium age: 63.8 ± 9.3 years between 2002 and 2008 with a histological confirmed SCC of the external auditory canal. The median follow-up period was 20.5 months (range 7-60 months). RESULTS The treatment involving surgery, radiotherapy and/or chemotherapy yielded a survival rate of 38.3 ± 11.3 months for T1 and a survival rate of 17.0 ± 3.0 months for T2-T4 tumors. 3/10 patients at T1 stage are under follow-up, all 7/10 (70%) patients at T2 and T4 stage did not survive 5 years. CONCLUSION The prognosis for ear SCC primarily depends on early clinical and histopathological diagnostics and requires a sufficient and standardized staging to determine the therapy involving surgery and radiochemotherapy.
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Affiliation(s)
- Franca Fleiner
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité, University of Berlin, Charité Campus Mitte Charitéplatz 1, 10117 Berlin, Germany
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