Management of Temporal Bone Malignancy in IrelandFunding No funding was received for this research.
20. April 2019
28. Juli 2019
29. August 2019 (online)
Objectives Lateral temporal bone malignancy remains a challenging rare disease. We report 17 years of multidisciplinary care of these tumors with univariate and multivariate analyses of key prognostic indicators for consideration in contemporary oncological management.
Design This is a retrospective cohort study.
Setting This is set at a tertiary referral center.
Participants All patients presenting with histopathologically newly diagnosed cases of temporal bone malignancy between 2000 and 2017 were included.
Main Outcome Measures The main outcome measures are disease-specific and recurrence-free survival rates.
Results In this study, 48 cases of temporal bone malignancy were diagnosed. Median age at diagnosis was 69 years (range: 5–88). Fourteen patients were female. Squamous cell carcinoma was the predominant malignancy in 34 cases (71%). Surgical treatment was undertaken in 37 patients. Mean length of follow-up was 32 months (range: 0.7–117). Overall 5-year disease-specific survival was 52.4%, while overall 5-year recurrence-free survival was 53.5%. On univariate analysis, significantly worse survival was seen in females (p = 0.008), those with distant metastatic disease (p = 0.041), and in middle ear involvement (p = 0.012) with no difference for involvement of the external auditory canal (p = 0.98) or mastoid (p = 0.78). Only middle ear involvement remained significant on multivariate analysis.
Conclusion A wide variety of malignant pathology may present in the temporal bone. Recurrence-free survival is equivalent to international data; however, this figure is low. This emphasizes the need to treat these tumors appropriately with radical resection, where possible, at first presentation. Therefore, multidisciplinary surgical input is recommended. Middle ear involvement was a negative prognosticator for disease-specific and recurrence-free survivals.
Keywordstemporal bone malignancy - squamous cell carcinoma - temporal bone resection - middle ear involvement - skull base
Data from this article were presented at the British Skull Base Society Meeting, Liverpool, England on January 26, 2018, and 6th World Congress of the International Federation of Head and Neck Oncologic Societies, Buenos Aires, September 4, 2018.
- 1 Gidley PW, Thompson CR, Roberts DB, DeMonte F, Hanna EY. The oncology of otology. Laryngoscope 2012; 122 (02) 393-400
- 2 Shen W, Sakamoto N, Yang L. Prognostic models to predict overall and cause-specific survival for patients with middle ear cancer: a population-based analysis. BMC Cancer 2014; 14: 554
- 3 Lionello M, Stritoni P, Facciolo MC. , et al. Temporal bone carcinoma. Current diagnostic, therapeutic, and prognostic concepts. J Surg Oncol 2014; 110 (04) 383-392
- 4 Brant JA, Eliades SJ, Chen J, Newman JG, Ruckenstein MJ. Carcinoma of the middle ear: a review of the National Cancer Database. Otol Neurotol 2017; 38 (08) 1153-1157
- 5 Gidley PW, Roberts DB, Sturgis EM. Squamous cell carcinoma of the temporal bone. Laryngoscope 2010; 120 (06) 1144-1151
- 6 House JW, Brackmann DE. Facial nerve grading system. Otolaryngology–Head Neck Surg 1985; 93 (02) 146-147
- 7 Dean NR, White HN, Carter DS. , et al. Outcomes following temporal bone resection. Laryngoscope 2010; 120 (08) 1516-1522
- 8 Madsen AR, Gundgaard MG, Hoff CM. , et al. Cancer of the external auditory canal and middle ear in Denmark from 1992 to 2001. Head Neck 2008; 30 (10) 1332-1338
- 9 Zanoletti E, Danesi G. The problem of nodal disease in squamous cell carcinoma of the temporal bone. Acta Otolaryngol 2010; 130 (08) 913-916
- 10 Zanoletti E, Marioni G, Franchella S. , et al. Recurrent squamous cell carcinoma of the temporal bone: critical analysis of cases with a poor prognosis. Am J Otolaryngol 2015; 36 (03) 352-355
- 11 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
- 12 Choi J, Kim SH, Koh YW, Choi EC, Lee CG, Keum KC. Tumor stage-related role of radiotherapy in patients with an external auditory canal and middle ear carcinoma. Cancer Res Treat 2017; 49 (01) 178-184
- 13 Wierzbicka M, Niemczyk K, Bruzgielewicz A. , et al. Multicenter experiences in temporal bone cancer surgery based on 89 cases. PLoS One 2017; 12 (02) e0169399
- 14 Bibas AG, Ward V, Gleeson MJ. Squamous cell carcinoma of the temporal bone. J Laryngol Otol 2008; 122 (11) 1156-1161
- 15 Zanoletti E, Marioni G, Stritoni P. , et al. Temporal bone squamous cell carcinoma: analyzing prognosis with univariate and multivariate models. Laryngoscope 2014; 124 (05) 1192-1198
- 16 O'Connor A, Behan L, Toner M, Kinsella J, Beausang E, Timon C. Evaluating the outcomes of temporal bone resection in metastatic cutaneous head and neck malignancies: 13-year review. J Laryngol Otol 2015; 129 (10) 964-969
- 17 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
- 18 Gupta R, Sandison A, Wenig BM, Thompson LDR. Data set for the reporting of ear and temporal bone tumors: explanations and recommendations of the guidelines from the International Collaboration on Cancer Reporting. Arch Pathol Lab Med 2019; 143 (05) 593-602
- 19 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
- 20 Morris LG, Mehra S, Shah JP, Bilsky MH, Selesnick SH, Kraus DH. Predictors of survival and recurrence after temporal bone resection for cancer. Head Neck 2012; 34 (09) 1231-1239
- 21 Zanoletti E, Marioni G, Franchella S. , et al. Temporal bone carcinoma: classical prognostic variables revisited and modern clinico-pathological evidence. Rep Pract Oncol Radiother 2016; 21 (04) 386-390
- 22 Schmedes GW, Rizk HG, Lambert PR. Middle ear mass with facial weakness. Diffuse large B-cell lymphoma of the middle ear. JAMA Otolaryngol Head Neck Surg 2015; 141 (01) 89-90
- 23 Alqunaee M, Aldaihani A, AlHajery M. Non-Hodgkin's lymphoma of the middle ear presenting as mastoiditis. Case Rep Otolaryngol 2018; 2018: 7639784
- 24 Shiga K, Katagiri K, Saitoh D, Ogawa T, Higashi K, Ariga H. Long-term outcomes of patients with squamous cell carcinoma of the temporal bone after concomitant chemoradiotherapy. J Neurol Surg B Skull Base 2018; 79 (Suppl. 04) S316-S321
- 25 Higgins TS, Antonio SA. The role of facial palsy in staging squamous cell carcinoma of the temporal bone and external auditory canal: a comparative survival analysis. Otol Neurotol 2010; 31 (09) 1473-1479
- 26 Leong SC, Youssef A, Lesser TH. Squamous cell carcinoma of the temporal bone: outcomes of radical surgery and postoperative radiotherapy. Laryngoscope 2013; 123 (10) 2442-2448
- 27 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
- 28 Marioni G, Zanoletti E, Lovato A. , et al. Relaxin-2 expression in temporal bone carcinoma. Eur Arch Otorhinolaryngol 2015; 272 (11) 3225-3232
- 29 Moncrieff MD, Hamilton SA, Lamberty GH. , et al. Reconstructive options after temporal bone resection for squamous cell carcinoma. J Plast Reconstr Aesthet Surg 2007; 60 (06) 607-614
- 30 Barrs DM. Temporal bone carcinoma. Otolaryngol Clin North Am 2001; 34 (06) 1197-1218 , x
- 31 Moffat DA, Grey P, Ballagh RH, Hardy DG. Extended temporal bone resection for squamous cell carcinoma. Otolaryngol Head Neck Surg 1997; 116 (06) 617-623
- 32 Tsunoda A, Sumi T, Terasaki O, Kishimoto S. Right dominance in the incidence of external auditory canal squamous cell carcinoma in the Japanese population: does handedness affect carcinogenesis?. Laryngoscope Investig Otolaryngol 2017; 2 (01) 19-22
- 33 Gaio E, Marioni G, Blandamura S, Staffieri A. Inverted papilloma involving the temporal bone and its association with squamous cell carcinoma: critical analysis of the literature. Expert Rev Anticancer Ther 2005; 5 (02) 391-397
- 34 Jin YT, Tsai ST, Li C. , et al. Prevalence of human papillomavirus in middle ear carcinoma associated with chronic otitis media. Am J Pathol 1997; 150 (04) 1327-1333
- 35 Monem SA, Moffat DA, Frampton MC. Carcinoma of the ear: a case report of a possible association with chlorinated disinfectants. J Laryngol Otol 1999; 113 (11) 1004-1007
- 36 Lim LH, Goh YH, Chan YM, Chong VF, Low WK. Malignancy of the temporal bone and external auditory canal. Otolaryngol Head Neck Surg 2000; 122 (06) 882-886
- 37 Lustig LR, Jackler RK, Lanser MJ. Radiation-induced tumors of the temporal bone. Am J Otol 1997; 18 (02) 230-235