title: Evidence-based surgical management of T1 or T2 temporal bone malignancies.
abstract: OBJECTIVE
  To determine whether aggressive surgical management is more effective than local canal resection (LCR) for early-stage temporal bone malignancies.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Forty-three cases of early-stage external auditory canal (EAC) carcinoma who received surgical management between 1993 and 2011 were reviewed. Preoperative computed tomography, enhanced magnetic resonance imaging, pure-tone audiometry, and biopsy were performed. Patients underwent either LCR or lateral temporal bone resection (LTBR). Postoperative pathologic examinations were conducted on all specimens, including assessment of margin status. The duration of the postoperative follow-up period ranged from 6 months to 18 years.
  
  
  RESULTS
  Of 26 patients who underwent LCR, 10 were stage T1 and 16 were T2. Positive surgical margins were identified in 14 patients. During the follow-up, 12 patients developed recurrence. Of 17 patients who underwent LTBR with superficial parotidectomy, six were stage T1 and 11 were T2. The lateral EAC margins were negative in all 17 patients. In 2/6 T1 patients and in 5/11 T2 patients, tumor cells were identified deep within the EAC cartilage and parotid gland. All of the patients who underwent LTBR survived without evidence of recurrence.
  
  
  CONCLUSIONS
  LTBR with superficial parotidectomy offers the greatest chance of cure for early-stage EAC carcinoma. Intraoperative frozen sections are necessary to determine the tumor-free lateral EAC margins. Postoperative radiotherapy is not strongly recommended for early-stage EAC carcinoma after LTBR.
authors.affiliation: Department of Otology and Skull Base Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Chunfu
authors.initials: C
authors.lastname: Dai
authors.forename: Fanglu
authors.initials: F
authors.lastname: Chi
authors.forename: Shuyi
authors.initials: S
authors.lastname: Wang
authors.forename: Zhengmin
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001299:Audiometry; D004424:Ear Canal / Q000473:pathology* / Q000601:surgery; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000601:surgery*; D013701:Temporal Bone / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome