Download PDF
CC BY 4.0 · J Neurol Surg B Skull Base 2023; 84(01): 069-078
DOI: 10.1055/a-1733-2585
Original Article

Surgical Strategy for Squamous Cell Carcinoma of the External Auditory Canal: Management of Locally Advanced Cases with Skull Base Involvement

Seiya Goto
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Naoki Nishio 
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Kenichiro Iwami
2   Department of Neurosurgery, Aichi Medical University, Aichi, Japan
,
Tadao Yoshida
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Takashi Maruo
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Nobuaki Mukoyama
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Hidenori Tsuzuki
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Sayaka Yokoi
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Akihisa Wada
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Mariko Hiramatsu
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Yuichiro Hayashi
3   Graduate School of Informatics, Nagoya University, Nagoya, Japan
,
Yuzuru Kamei
4   Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Masazumi Fujii
5   Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
,
Michihiko Sone
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Yasushi Fujimoto
1   Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
6   Department of Otorhinolaryngology, Head and Neck Surgery, Aichi Medical University, Aichi, Japan
› Author Affiliations
› Further Information
   Permissions and Reprints

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.

Keywords

external auditory canal cancer - squamous cell carcinoma - surgical strategy - overall survival - disease-specific survival - T4 subclassification

Author Contributions

S.G. and N.N. designed the study, analyzed the results, and drafted the manuscript. Data collection was performed by all the authors. M.S. and Y.F. supervised the study and assisted in preparation of the manuscript. All authors reviewed and approved the final version of the manuscript.


Supplementary Material



Publication History

Received: 27 August 2021

Accepted: 04 January 2022

Accepted Manuscript online:
07 January 2022

Article published online:
04 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Barrs DM. Temporal bone carcinoma. Otolaryngol Clin North Am 2001; 34 (06) 1197-1218 , x
    CrossrefPubMedGoogle Scholar
  • 2 Moody SA, Hirsch BE, Myers EN. Squamous cell carcinoma of the external auditory canal: an evaluation of a staging system. Am J Otol 2000; 21 (04) 582-588
    PubMedGoogle Scholar
  • 3 Shinomiya H, Uehara N, Teshima M, Kakigi A, Otsuki N, Nibu KI. Clinical management for T1 and T2 external auditory canal cancer. Auris Nasus Larynx 2019; 46 (05) 785-789
    CrossrefPubMedGoogle Scholar
  • 4 Allanson BM, Low TH, Clark JR, Gupta R. Squamous cell carcinoma of the external auditory canal and temporal bone: an update. Head Neck Pathol 2018; 12 (03) 407-418
    CrossrefPubMedGoogle Scholar
  • 5 Lovin BD, Gidley PW. Squamous cell carcinoma of the temporal bone: a current review. Laryngoscope Investig Otolaryngol 2019; 4 (06) 684-692
    CrossrefPubMedGoogle Scholar
  • 6 Lechner M, Sutton L, Murkin C. et al. Squamous cell cancer of the temporal bone: a review of the literature. Eur Arch Otorhinolaryngol 2021; 278 (07) 2225-2228
    CrossrefPubMedGoogle Scholar
  • 7 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 2015; 37 (07) 1073-1080
    CrossrefPubMedGoogle Scholar
  • 8 Yin M, Ishikawa K, Honda K. et al. Analysis of 95 cases of squamous cell carcinoma of the external and middle ear. Auris Nasus Larynx 2006; 33 (03) 251-257
    CrossrefPubMedGoogle Scholar
  • 9 Morita S, Mizumachi T, Nakamaru Y. et al. Comparison of the University of Pittsburgh staging system and the eighth edition of the American Joint Committee on Cancer TNM classification for the prognostic evaluation of external auditory canal cancer. Int J Clin Oncol 2018; 23 (06) 1029-1037
    CrossrefPubMedGoogle Scholar
  • 10 Pfreundner L, Schwager K, Willner J. et al. Carcinoma of the external auditory canal and middle ear. Int J Radiat Oncol Biol Phys 1999; 44 (04) 777-788
    CrossrefPubMedGoogle Scholar
  • 11 Nishio N, Fujimoto Y, Fujii M. et al. Craniofacial resection for T4 maxillary sinus carcinoma: managing cases with involvement of the skull base. Otolaryngol Head Neck Surg 2015; 153 (02) 231-238
    CrossrefPubMedGoogle Scholar
  • 12 Matoba T, Hanai N, Suzuki H. et al. Treatment and outcomes of carcinoma of the external and middle ear: the validity of en bloc resection for advanced tumor. Neurol Med Chir (Tokyo) 2018; 58 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 13 Komune N, Noda T, Kogo R. et al. Primary advanced squamous cell carcinoma of the temporal bone: a single-center clinical study. Laryngoscope 2021; 131 (02) E583-E589
    CrossrefPubMedGoogle Scholar
  • 14 Nabuurs CH, Kievit W, Labbé N. et al. Evaluation of the modified Pittsburgh classification for predicting the disease-free survival outcome of squamous cell carcinoma of the external auditory canal. Head Neck 2020; 42 (12) 3609-3622
    CrossrefPubMedGoogle Scholar
  • 15 Arriaga M, Curtin H, Takahashi H, Hirsch BE, Kamerer DB. Staging proposal for external auditory meatus carcinoma based on preoperative clinical examination and computed tomography findings. Ann Otol Rhinol Laryngol 1990; 99 (9, Pt 1): 714-721
    CrossrefPubMedGoogle Scholar
  • 16 Ito E, Fujii M, Hayashi Y. et al. Magnetically guided 3-dimensional virtual neuronavigation for neuroendoscopic surgery: technique and clinical experience. Neurosurgery 2010;66(6, Suppl Operative):342–353, discussion 353
    PubMedGoogle Scholar
  • 17 Nishio N, Fujii M, Hayashi Y. et al. Preoperative surgical simulation and validation of the line of resection in anterolateral craniofacial resection of advanced sinonasal sinus carcinoma. Head Neck 2017; 39 (03) 512-519
    CrossrefPubMedGoogle Scholar
  • 18 Oken MM, Creech RH, Tormey DC. et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5 (06) 649-655
    CrossrefPubMedGoogle Scholar
  • 19 Omura G, Ando M, Saito Y. et al. Survival impact of local extension sites in surgically treated patients with temporal bone squamous cell carcinoma. Int J Clin Oncol 2017; 22 (03) 431-437
    CrossrefPubMedGoogle Scholar
  • 20 Stell PM, McCormick MS. Carcinoma of the external auditory meatus and middle ear. Prognostic factors and a suggested staging system. J Laryngol Otol 1985; 99 (09) 847-850
    CrossrefPubMedGoogle Scholar
  • 21 Amin MB, Edge SB, Greene FL. et al. AJCC Cancer Staging Manual. 8th ed.. New York, NY: Springer; 2017
    CrossrefGoogle Scholar
  • 22 Komune N, Miyazaki M, Sato K. et al. Prognostic impact of tumor extension in patients with advanced temporal bone squamous cell carcinoma. Front Oncol 2020; 10 (08) 1229
    CrossrefPubMedGoogle Scholar
  • 23 Shinomiya H, Hasegawa S, Yamashita D. et al. Concomitant chemoradiotherapy for advanced squamous cell carcinoma of the temporal bone. Head Neck 2016; 38 (Suppl. 01) E949-E953
    CrossrefPubMedGoogle Scholar
  • 24 Moore MG, Deschler DG, McKenna MJ, Varvares MA, Lin DT. Management outcomes following lateral temporal bone resection for ear and temporal bone malignancies. Otolaryngol Head Neck Surg 2007; 137 (06) 893-898
    CrossrefPubMedGoogle Scholar
  • 25 Bacciu A, Clemente IA, Piccirillo E, Ferrari S, Sanna M. Guidelines for treating temporal bone carcinoma based on long-term outcomes. Otol Neurotol 2013; 34 (05) 898-907
    CrossrefPubMedGoogle Scholar
  • 26 Yokoi S, Nishio N, Fujimoto Y. et al. Feasibility of virtual surgical simulation in the head and neck region for soft tissue reconstruction using free flap: a comparison of preoperative and postoperative volume measurement. Int J Oral Maxillofac Surg 2021; 50 (03) 316-322
    CrossrefPubMedGoogle Scholar
  • 27 Moffat DA, Wagstaff SA, Hardy DG. The outcome of radical surgery and postoperative radiotherapy for squamous carcinoma of the temporal bone. Laryngoscope 2005; 115 (02) 341-347
    CrossrefPubMedGoogle Scholar
  • 28 Lobo D, Llorente JL, Suárez C. Squamous cell carcinoma of the external auditory canal. Skull Base 2008; 18 (03) 167-172
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 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 (04) 259-266
    CrossrefPubMedGoogle Scholar
  • 30 Adachi Y, Kimura H, Sato N. et al. Preoperative level of depression is a predictor of postoperative levels of depression in patients with head and neck cancer. Jpn J Clin Oncol 2014; 44 (04) 311-317
    CrossrefPubMedGoogle Scholar
  • 31 Mukoyama N, Nishio N, Kimura H. et al. Prospective evaluation of health-related quality of life in patients undergoing anterolateral craniofacial resection with orbital exenteration. J Neurol Surg B Skull Base 2020; 81 (05) 585-593
    Article in Thieme ConnectPubMedGoogle Scholar