title: Squamous cell carcinoma of the external auditory canal and middle ear: an operation combined with preoperative chemoradiotherapy and a free surgical margin.
abstract: OBJECTIVE
  Treatment outcomes for squamous cell carcinoma of the temporal bone were evaluated regarding stage, therapeutic strategy, and prognostic factors.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  University hospital and outpatient clinic.
  
  
  METHODS
  Twenty-five patients with primary squamous cell carcinoma of the external auditory canal and middle ear.
  
  
  METHODS
  Preoperative chemoradiotherapy and radiotherapy were used in 7 of 12 patients. Lateral temporal bone resection was performed for the lesions not beyond the tympanic membrane. Subtotal temporal bone resection was chosen for lesions extending to the middle ear cavity when there was no invasion to the pyramidal apex, carotid canal, or dura or metastasis. Others were conservatively treated by chemoradiotherapy. When the performance status was poor or an agreement regarding the operation could not be reached, the treatment was modified.
  
  
  METHODS
  Estimated survival rates.
  
  
  RESULTS
  The 3-year estimated survival for T1 and T2 lesions was 100%. The 5-year estimated survival for T3 and T4 lesions was 80% and 35%, respectively. The 5-year estimated survival improved up to 75% for T4 tumors with operation and 16% for those without operation after 47 months. The tumor-free surgical margin is significantly related to patient survival in T3 and T4 lesions. Multivariate analysis predicted that concomitant chronic otitis media and positive lymph nodes were significantly associated with poorer survival.
  
  
  CONCLUSIONS
  The tumor-free surgical margin was important to survival. When T4 lesions did not involve the pyramidal apex, carotid canal, dura, or any lymph nodes, the surgical intervention improved the estimated survival rate to a level as good as T3 lesions.
authors.affiliation: Department of Otorhinolaryngology, Faculty of Medicine, Kyushu University, Fukuoka, Japan. nakataka@qent.med.kyushu-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kumamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Natori
authors.forename: Hideki
authors.initials: H
authors.lastname: Shiratsuchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toh
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kakazu
authors.forename: Shumei
authors.initials: S
authors.lastname: Shibata
authors.forename: Torahiko
authors.initials: T
authors.lastname: Nakashima
authors.forename: Shizuo
authors.initials: S
authors.lastname: Komune
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004424:Ear Canal / Q000473:pathology / Q000601:surgery*; D004428:Ear Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D004432:Ear, Middle / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome