Management of Squamous Cell Carcinoma in the Ear

The treatments for carcinomas of in the ear are still controversial and those for advanced tumor are still formidable trial for clinicians. For squamous cell carcinoma, radiotherapy and/ or surgery are performed as a radical therapy and both therapies have merits and demerits. Most reliable therapeutic choice is the total removal with sufficient margin, however, safe and sufficient surgery of the temporal bone is difficult because of anatomical complexity. Purpose this study is to evaluate the surgical outcomes comparing to image studies and histopathological findings in squamous cell carcinoma cases. The cases with direct invasions to the carotid artery, cerebrum and cerebellum or positive for distant metastasis on the image study were excluded from surgical treatment. Except for those cases, including cases showing invasions to the dura mater or sigmoid sinus, 24 consecutive cases of carcinomas in the temporal bone underwent surgical removal of the tumor and were enrolled for the present study. Surgical approach, area of removal were decided based on computed tomography and magnetic resonance imaging (MRI). The preoperative images and histopathology are carefully investigated. Lateral petrosectomy were applied for 12 cases and total petrosectomy was for 12 cases. Tumor was totally removed with tumor-free margins in all cases. Nevertheless, 4 out of 20 cases with histological negative margins developed recurrence. Three cases showed recurrence in the parapharygeal space and/ or premolar areas. Although other metastatic nodes were not observed in the specimen obtained from neck dissection. The rest of a case showed multiple distant metastases. These recurrences were observed from 6 to 12 month after the surgery. These recurrences were observed in the regions where no significant uptakes on FDG-PET scanning. The other cases live without tumor recurrence with mean follow-up periods of 4 years. Based on an appropriate image assessments, surgical removals of these tumors warrant good therapeutic outcomes. However, latent metastasis which could not be detected by preoperative imaging study may affect the prognosis. On the other hand, CyberKnife had been allied to 17 patients who refuse surgical intervention or could not tolerate surgery. Eight patients were suffered concomitant oral intake of S-1 and other nine were CyberKnife alone. Two patients with S-1 and 3 patient without S-1 showed complete remission for 2–5 year periods. Other cases showed recurrence within an year. Although less invasive for the patients, CyberKnife needs careful follow up after the therapy.