title: Guidelines for treating temporal bone carcinoma based on long-term outcomes.
abstract: OBJECTIVE
  To describe our experience in the management of patients with squamous cell carcinoma of the temporal bone (TBSCC) and to identify factors predictive of outcome.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Quaternary referral otology and skull base center.
  
  
  METHODS
  A total of 45 consecutive patients with histologically confirmed TBSCC were treated surgically at our institution between 1993 and 2011. Patients were divided into 5 stage I (11.1%), 6 stage II (13.3%), 15 stage III (31.1%), and 19 stage IV tumors (42.2%) according to the University of Pittsburgh modified TNM staging system.
  
  
  METHODS
  Twenty-one patients underwent lateral temporal bone resection, and 24 underwent subtotal temporal bone resection. Postoperative radiotherapy was performed in 27 cases.
  
  
  RESULTS
  The 5-year disease-specific survival (DSS) and recurrence-free survival (RFS) for patients with early-stage disease (Stages I and II) was 100%. The 5-year DSS and RFS rates for patients with advanced disease (Stages III and IV) were 65.1% and 59.6%, respectively. On univariate analysis, factors that had a significant effect on both DSS and RFS were advanced Pittsburgh stage, presence of facial nerve palsy, positive tumor margins, and invasion of the fallopian canal, medial wall, middle ear, mastoid, temporomandibular joint, jugular bulb, and dura. Multivariable analysis identified only dural involvement as an independent predictor for both DSS and RFS.
  
  
  CONCLUSIONS
  In this study, the Pittsburg staging system allowed an estimation of the prognosis. In fact, the prognosis of TBSCC was strictly correlated to tumor stage. The poor prognosis of advanced stage tumors underlines the importance of early diagnosis. Surgery with or without adjuvant radiotherapy remains the standard of care in the treatment of TBSCC.
authors.affiliation: Head and Neck Department, University-Hospital of Parma, Parma, Italy. andreabacciu@yahoo.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacciu
authors.forename: Ignazio Alessandro
authors.initials: IA
authors.lastname: Clemente
authors.forename: Enrico
authors.initials: E
authors.lastname: Piccirillo
authors.forename: Silvano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Mario
authors.initials: M
authors.lastname: Sanna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004428:Ear Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D004432:Ear, Middle / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D013701:Temporal Bone / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome