Mediterr J Otol 2005:1(2):70-79.

Management of carcinoma of the temporal bone

Lavieille JP., Delande C., Kunst H., Deveze A., Magnan J., Schmerber S.
Dept. Otolaryngology, hopital Nord, Marseille, France. jean-pierre.levieille@ap-hm.fr

OBJECTIVES: A retrospective study was performed to evaluate the management  of carcinoma of the external auditory canal and the middle ear.

PATIENTS AND METHODS: Thirty patients (14 women, 16 men; mean age 65 years; range 41 to 79 years) underwent treatment for carcinoma of the temporal bone between 1981 and 2002. Histopathological diagnoses were squamous cell carcinoma in 27 cases, adenoid cystic carcinoma in two cases, and melanoma in one case. Seventeen patients received primary treatment while 13 patients presented with residual disease after primary treatment. The patients were classified according to the classification system proposed by the Belgium Consensus Conference in March 2002. The mean follow-up period was five years (range 2 to 276 months).

RESULTS: The mean interval between the appearance of symptoms and first consultation was 22 months (range 1 to 168 months). The first symptoms were otalgia in 16 cases, otorrhea in 16 cases, bleeding from the ear in six cases, hearing impairment in 11 cases, facial paralysis in 11 cases, and neuralgia in two cases. Twelve patients had T1 and T2, six patients had T3, and 12 patients had T4 tumors. The Kaplan-Meier survival curves showed twoyear survival as 82%, 67%, and 32%, and five-year survival as 82%, 67%, and 17% for T1 or T2, T3, and T4, respectively. At the end of a follow-up period of nine years, the survival rates were 66%, 66%, and 17% for T1 or T2, T3, and T4, respectively. Overall, complete remission was found in 64.7% and 23.1%, and mortality rates were 35.3% and 76.9% for primary treatment and salvage surgery, respectively.

CONCLUSION: Long-term prognosis of carcinoma of the external auditory canal mainly depends on the stage and primary treatment. Surgery (lateral or subtotal temporal bone resection, in combination with neck dissection and parotidectomy) and adjuvant radiotherapy is the treatment of choice for part of stage T1 and all T2 and T3 tumors. In T1 tumors, histopathologically confirmed free excision margins may obviate radiotherapy. Additional subclassification based on extension of T4 tumors may be effective in advanced tumors. Surgery may be considered in T4a tumors, and palliative treatment in most T4b tumors and in all patients with T4c disease.