Unresectable Recurrent Squamous Cell Carcinoma of the Temporal Bone Treated by Induction Chemotherapy Followed by Concurrent Chemo-Reirradiation: A Case Report and Review of the Literature

OBJECTIVE

To report a rare case of recurrent temporal bone carcinoma encasing the carotid artery.

PATIENT

A 54-year-old man underwent mastoidectomy combined with adjuvant chemoradiotherapy of squamous cell carcinoma of the temporal bone. He developed metastatic disease and received parotidectomy and lymph node dissection. Three months later, the magnetic resonance imaging scan showed that the tumor had relapsed and invaded the carotid artery.

INTERVENTION

The patient completed TPF-C induction chemotherapy (docetaxel, cisplatin, 5-fluorouracil, cetuximab), followed by concurrent chemotherapy with reirradiation.

RESULTS

Magnetic resonance imaging revealed a complete response of tumor 1 month after treatment. The patient had no detectable recurrence after 53 months of follow-up.

CONCLUSION

Concurrent chemotherapy with reirradiation is a potential curative treatment option for patients who have unresectable recurrent squamous cell carcinoma of the temporal bone.

Impact of indication-shift of primary and adjuvant chemo radiation in advanced laryngeal and hypopharyngeal squamous cell carcinoma

Based on level I evidence, postoperative platinum-based radiochemotherapy (PORCT) is the recommended standard of care in defined risk situations after resection of squamous cell carcinomas of the larynx and hypopharynx (LHSCC). The value of the addition of chemotherapy to adjuvant radiation in intermediate and high risk situations other than extracapsular spread or R1-/R2 resection is still debated. From 1993 to 2009, 555 patients (median follow-up: 24.4 months) with advanced LHSCC (UICC stages III-IVB) were treated in a curative intent. Patient data were continuously documented in the county of Leipzig cancer registry and were retrospectively analyzed as mono institutional survey. PORCT was introduced into the standard procedures in 2004, but also applied before in selected cases. Based on this paradigm shift, the patient population was divided into two comparative groups treated before and after 2004. 361 patients were treated before 2004. 43.8 % received primary surgery (OP) + postoperative radiotherapy (PORT) and 20.2 % OP + PORCT. 194 patients were treated after 2004: 21.1 % received OP + PORT and 35.6 % OP + PORCT. Regarding the PORCT groups, 20.6 % received cisplatin plus 5FU before 2004 which shifted to 59.4 % after 2004. The 3-year tumor-specific-survival rate of the whole cohort was improved from 47 to 60 % (p = 0.006). The subgroup treated with OP + PORT or PORCT improved from 56.1 to 68.5 % (p = 0.028). Localization proved to be a significant and independent factor. Only patients with advanced laryngeal cancer had significant improved survival (p < 0.01), while the improvement for hypopharyngeal cancer patients was not significant (p < 0.2). After 2004, there was a slight increase (+10.2 %) of primary radiochemotherapy (pRCT) due to stronger selection if R0 > 5 mm-resectability is unlikely. Standardised use of PORCT and pRCT considering clear indications showed to be significantly involved in improved survival in advanced LHSCC.

[Multimodal laryngeal preservation: current data-based opinion]

This article presents the current data and discussion on multimodal laryngeal preservation strategies in advanced laryngeal/hypopharyngeal carcinoma. Principally a distinction is made between simultaneous and induction chemoradiation protocols. In terms of late toxicity and related functional limitations, induction protocols are far superior to simultaneous platinum-based chemoradiation. Currently, the individual response to the first cycle of (short) induction chemotherapy appears to be the most reliable clinical marker for making treatment decisions, and this is under clinical investigation. No standard multimodal therapeutic alternative to laryngectomy exists; therefore, at this time multimodal strategies should only be carried out within the framework of clinical trials.

[Induction chemotherapy for head and neck epidermoid carcinomas]

The standard treatment for head and neck inoperable squamous cell carcinoma is an association of radiotherapy and platinum. However, only one patient out of three remains alive five years after diagnosis. The interest in induction chemotherapy was renewed by the introduction of taxanes combined with cisplatinum and 5-fluoro-uracile. The triple association taxane-cisplatinum-5-fluoro-uracile yielded improved survival when compared to cisplatinum-5-fluoro-uracile. Wider use of taxane-cisplatinum-5-fluoro-uracile is limited by its toxicity and the lack of randomized comparison with a concomitant chemoradiotherapy scheme including optimal doses of platinum. Until the results of new phase III trials are published, the choice between induction chemotherapy followed by concomitant chemoradiotherapy or concomitant chemoradiotherapy alone has to be made on an individualized basis, taking into account the patient's medical condition, the ability of the medical team to deal with intensive treatment regimens, and the clinical/pathological characteristics of the tumour.