Abstract
Purpose
Temporal bone squamous cell carcinoma (TBSCC) is an uncommon, aggressive malignancy with a significant recurrence rate. We reviewed our experience with recurrent TBSCCs.
Materials and methods
Clinicopathological and therapeutic variables potentially associated with disease-free survival (DFS) and disease-specific survival (DSS) were assessed in 17 TBSCC patients who died of their disease after treatment.
Results
TBSCC recurrences were treated with surgery in 12 cases (palliative in 11, with curative intent in 1) and palliative chemotherapy in 5; the median DFS and DSS were 6 and 16 months, respectively. The mean DFS and DSS were longer in patients who had primary lateral temporal bone resection (LTBR) rather than subtotal temporal bone resection (STBR) (p = 0.0173 and p = 0.03, respectively). Patients given non-surgical palliative treatment for recurrences had a longer mean DSS than those who underwent surgery (trend toward significance, p = 0.09).
Conclusions
Our results reflect the aggressive nature of TBSCC recurrences. Our findings seem to support the use of non-surgical treatments (chemotherapy, radiotherapy, or specialist palliative care) in patients with loco-regionally advanced recurrent TBSCC. Salvage surgery might be considered for early recurrences when radicality is still achievable. Precise guidelines for the rational follow-up of surgically-treated TBSCCs need to be shared between tertiary centers.
1
Introduction
Squamous cell carcinoma (SCC) of the temporal bone is an uncommon malignancy, accounting for less than 0.2% of head and neck cancers. The annual incidence of such tumors is estimated to be between 1 and 6 per million population .
Although this malignancy’s rarity makes it difficult to compare diagnostic, therapeutic and prognostic results from single institutions, quite a significant local recurrence rate after surgery for temporal bone SCC has been widely reported . Salvage treatment for recurrences has been associated with a worse prognosis than after primary treatment: patients whose disease recurred were found more likely to recur again after further treatment . The disease-related fatality rate is significant for patients developing recurrent temporal bone SCC after treatment. In a detailed review of the available literature (1995–2013) on temporal bone SCC, Lionello et al. very recently found that disease-specific survival for cases in stages III–IV ranged from 18% to 65%.
The main aim of the present investigation was to critically assess our experience of diagnosing and treating recurrent temporal bone SCCs. A secondary goal was a statistical analysis of the variables potentially related to disease-specific survival time for our patients who died of recurrent temporal bone SCC. To the best of our knowledge, this is the first attempt to conduct a detailed clinical analysis of a consecutive series of patients who died of recurrent temporal bone SCC.
2
Materials and methods
The clinical charts of 42 patients consecutively operated by the same surgeon (A. Mz.) for primary temporal bone SCC with a curative intent at a tertiary referral center between 1980 and 2008 were reviewed. On final histopathological examination, the surgical margins were negative in all cases.
The patients were followed up according to our clinical schedule (adjusted to patients’ individual characteristics) as follows: every 3 months in the 1st year; then 6-monthly up until the 5th year, then yearly. Neck ultrasonography and chest X-rays were also performed at least yearly. Contrast-enhanced head and neck MRI (or contrast-enhanced CT if MRI was unavailable) were performed every six months in the first year and yearly thereafter.
Eighteen patients developed local and/or regional recurrences of their temporal SCC a median 6 months after primary surgery. Seventeen (10 women and 7 men; mean age 59.8 ± 10.2 years at time of primary temporal bone SCC diagnosis) of the 18 patients died of their recurrent disease. One patient (male, 56 years old at time of primary temporal bone SCC diagnosis) died of other causes (primary lung carcinoma) while still free of temporal bone disease 150 months after surgery and radiotherapy for a regional (neck lymph node) recurrence of a pT4N0 primary temporal bone SCC.
Table 1 shows the main clinicopathological features (also according to the revised Pittsburgh staging system ) for the 17 patients with recurrent temporal bone SCC who died of their disease.
| No. of cases | Mean disease-free survival interval (± SD) in months | Mean disease-specific survival time (± SD) in months | |
|---|---|---|---|
| cT stage ⁎ | |||
| cT2 | 2 | 6.0 ± 0.0 | 23.0 ± 14.0 |
| cT3 | 6 | 4.3 ± 3.0 | 16.5 ± 10.3 |
| cT4 | 9 | 13.9 ± 16.3 | 22.6 ± 15.8 |
| Primary surgery | |||
| LTBR | 9 | 14.3 ± 15.7 | 27.2 ± 14.7 |
| STBR | 8 | 4.3 ± 4.4 | 12.9 ± 8.8 |
| Approach to facial nerve | |||
| Facial nerve sacrificed | 11 | 8.1 ± 10.8 | 17.5 ± 12.1 |
| Facial nerve spared | 6 | 12.3 ± 15.5 | 25.8 ± 16.1 |
| pT stage ⁎ | |||
| pT2 | 1 | – | – |
| pT3 | 2 | 6.0 ± 0.0 | 12.0 ± 4.0 |
| pT4 | 14 | 10.4 ± 14.1 | 20.5 ± 14.6 |
| Dura mater involvement ⁎ | |||
| Dura mater involved | 7 | 6.6 ± 3.9 | 20.0 ± 9.3 |
| Dura mater uninvolved | 10 | 11.1 ± 16.1 | 20.8 ± 16.8 |
| N status ⁎ | |||
| pN + | 6 | 3.8 ± 1.7 | 12.8 ± 5.1 |
| N0 (cN 0 /pN 0 ) ⁎⁎ | 11 | 12.7 ± 15.0 | 24.6 ± 15.8 |
| rT stage † | |||
| rT4 | 17 | 9.6 ± 12.9 | 20.5 ± 14.2 |
| Pathological grading | |||
| G1 | 4 | 6.5 ± 5.1 | 19.5 ± 14.4 |
| G2 | 10 | 12.3 ± 15.9 | 22.0 ± 17.7 |
| G3 | 3 | 4.7 ± 1.9 | 16.7 ± 4.1 |
| Treatment of recurrence | |||
| Chemotherapy ‡ | 5 | 15.2 ± 16.5 | 30.6 ± 15.3 |
| Surgery ∂ | 12 | 7.3 ± 10.1 | 16.2 ± 11.3 |
⁎ Primary temporal bone SCC staging.
⁎⁎ cN 0 4 cases and pN 0 7 cases.
† Recurrent temporal bone SCC staging.
2.1
Statistical analysis
The statistical method applied was the Kruskal–Wallis test. Disease-free survival (DFS) interval was expressed as the number of months elapsing between ending any primary treatment and identifying the carcinoma recurrence. Disease-specific survival (DSS) time was expressed as the number of months elapsing between ending any primary treatment and death due to the temporal bone SCC recurrence.
A p-value < 0.05 was considered significant, while values in the range of 0.10 ≥ p ≥ 0.05 were defined to indicate a statistical trend. The STATA™ 8.1 (Stata Corp, College Station, TX) statistical package was used for all analyses.
2
Materials and methods
The clinical charts of 42 patients consecutively operated by the same surgeon (A. Mz.) for primary temporal bone SCC with a curative intent at a tertiary referral center between 1980 and 2008 were reviewed. On final histopathological examination, the surgical margins were negative in all cases.
The patients were followed up according to our clinical schedule (adjusted to patients’ individual characteristics) as follows: every 3 months in the 1st year; then 6-monthly up until the 5th year, then yearly. Neck ultrasonography and chest X-rays were also performed at least yearly. Contrast-enhanced head and neck MRI (or contrast-enhanced CT if MRI was unavailable) were performed every six months in the first year and yearly thereafter.
Eighteen patients developed local and/or regional recurrences of their temporal SCC a median 6 months after primary surgery. Seventeen (10 women and 7 men; mean age 59.8 ± 10.2 years at time of primary temporal bone SCC diagnosis) of the 18 patients died of their recurrent disease. One patient (male, 56 years old at time of primary temporal bone SCC diagnosis) died of other causes (primary lung carcinoma) while still free of temporal bone disease 150 months after surgery and radiotherapy for a regional (neck lymph node) recurrence of a pT4N0 primary temporal bone SCC.
Table 1 shows the main clinicopathological features (also according to the revised Pittsburgh staging system ) for the 17 patients with recurrent temporal bone SCC who died of their disease.
