Survival in Primary Carcinoma of the External and Middle Ear Is Strongly Dependent on Stage at Diagnosi

Toru Ugumori, Jun Hyodo, Naohito Hato, Kiyofumi Gyo

Department of Otolaryngology, Takanoko Hospital, Matsuyama, Japan.
Departmentof Otolaryngology, Ehime University, Toon, Japan.

DOI: 10.4236/ijohns.2013.26046                

Abstract

Conclusion: Early-stage detection of temporal bone carcinoma improves the survival rate. When detected at an advanced stage, predicted prognosis is poor even with a combination of surgery, radiotherapy and chemotherapy. Objectives: We evaluated treatment strategies and survival rates in cases of carcinomas of the external and middle ear. Method: Retrospective review of patients treated at Ehime University Hospital during the 32 years from 1977 to 2008. Subjects were 41 patients, consisting of 21 men and 20 women with a mean age of 63.2 years. Modified Pittsburgh staging system: stage I in 11 cases (27%), stage II in 4 (10%), stage III in 6 (15%) and stage IV in 20 (49%). Histopathology: squamous cell carcinoma (SCC) in 35 cases, adenoid cystic carcinoma (ACC) in 3, and adenocarcinoma (AC) in 3. Thirty-eight patients were treated by surgery. Radiation was added postoperatively in 23 patients. Three patients were treated by chemoradiotherapy. Results: The survival rate of carcinomas detected at an advanced stage was poor with a disease-specific 5-year survival rate of 100% in early-stage disease (stage I and II) versus 20.8% in stage III and 27.5% in stage IV disease, irrespective of histopathology of the tumor.

Keywords

Survival; Staging; External Auditory Canal; Middle Ear

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. E. Kinney and B. G. Wood, “Malignancies of the External Ear Canal and Temporal Bone: Surgical Techniques and Results,” Laryngoscope, Vol. 97, No. 2, 1987, pp. 158-164. http://dx.doi.org/10.1288/00005537-198702000-00006
[2]	W. I. Kuhel, C. R. Hume and S. H. Selesnick, “Cancer of the External Auditory Canal and Temporal Bone,” Otolaryngologic Clinics of North America, Vol. 29, No. 5, 1996, pp. 827-852.
[3]	P. M. Stell and M. S. McCormick, “Carcinoma of the External Auditory Meatus and Middle Ear. Prognostic Factors and a Suggested Staging System,” The Journal of Laryngology & Otology, Vol. 99, No. 9, 1985, pp. 847-850. http://dx.doi.org/10.1017/S0022215100097796
[4]	S. A. Moody, B. E. Hirsch and E. N. Meyers, “Squamous Cell Carcinoma of the External Auditory Canal: An Evaluation of a Staging System,” American Journal of Otolaryngology, Vol. 21, No. 4, 2000, pp. 582-588.
[5]	C. H. Chang, M. T. Shu, J. C. Lee, Y. S. Leu, Y. C. Chen and K. S. Lee, “Treatments and Outcomes of Malignant Tumors of External Auditory Canal,” American Journal of Otolaryngology, Vol. 30, No. 1, 2009, pp. 44-48. http://dx.doi.org/10.1016/j.amjoto.2008.02.007
[6]	M. Yin, K. Ishikawa, K. Honda, T. Arakawa, Y. Harabuchi, T. Nagabashi, et al., “Analysis of 95 Cases of Squamous Cell Carcinoma of the External and Middle Ear,” Auris Nasus Larynx, Vol. 33, No. 3, 2006, pp. 251-257. http://dx.doi.org/10.1016/j.anl.2005.11.012
[7]	M. Varyberg and R. T. Sataloff, “Hearing Loss. Chapter 21. Squamous Cell Carcinoma of Temporal Bone,” R. T. Sataloff and J. Sataloff, Eds., Taylor & Francis, New York/London, 2005, pp. 545-571.
[8]	H. Sugimoto, M. Ito, M. Hatano, S. Kondo, S. Suzuki and T. Yoshizaki, “Roles of Epithelial-Mesenchymal Transition in Squamous Cell Carcinoma of the Temporal Bone,” Otology & Neurotology, Vol. 32, No. 3, 2011, pp. 483-487. http://dx.doi.org/10.1097/MAO.0b013e31820d9654
[9]	L. S. Pemberton, R. Swindell and A. J. Sykes, “Primary Radical Radiotherapy for Squamous Cell Carcinoma of the Middle Ear and External Auditory Canal: An Historical Series,” Journal of Clinical Oncology, Vol. 18, No. 5, 2006, pp. 390-394. http://dx.doi.org/10.1016/j.clon.2006.03.001
[10]	A. R. Birzgalis, A. O. Keith and W. T. Farrington, “Radiotherapy in the Treatment of Middle Ear and Mastoid Carcinoma,” Clinical Otolaryngology and Allied Sciences, Vol. 17, No. 2, 1992, pp. 113-116. http://dx.doi.org/10.1111/j.1365-2273.1992.tb01055.x
[11]	R. K. Gurgel, L. H. Karnell and M. R. Hansen, “Middle Ear Cancer: A Population-Based Study,” Laryngoscope, Vol. 119, No. 10, 2009, pp. 1913-1917. http://dx.doi.org/10.1002/lary.20202
[12]	R. R. Gacek and M. Goodman, “Management of Malignancy of the Temporal Bone,” Laryngoscope, Vol. 87, No. 10, 1977, pp. 1622-1634. http://dx.doi.org/10.1288/00005537-197710000-00003
[13]	J. G. Spector, “Management of Temporal Bone Carcinomas: A Therapeutic Analysis of Two Groups of Patients and Long-Term Followup,” Otolaryngology-Head and Neck Surgery, Vol. 104, No. 1, 1991, pp. 58-66.
[14]	L. Pfreundner, K. Schwager, J. Willner, K. Baier, K. Bratengeier, F. X. Brunner, et al., “Carcinoma of the External Auditory Canal and Middle Ear,” International Journal of Radiation Oncology*Biology*Physics, Vol. 44, No. 4, 1999, pp. 777-788.
[15]	T. Nakagawa, Y. Kumamoto, Y. Natori, H. Shiratsuchi, S. Toh, Y. Kakazu, S. Shibata, T. Nakashima and S. Komune, “Squamous Cell Carcinoma of the External Auditory Canal and Middle Ear: An Operation Combined with Preoperative Chemoradiotherapy and a Free Surgical Margin,” Otology Neurotology, Vol. 27, No. 2, 2006, pp. 242-249. http://dx.doi.org/10.1097/01.mao.0000190463.88873.3d
[16]	Y. Ueda, T. Kurita, Y. Matsuda, S. Ito and T. Nakashima, “Superselective, Intra-Arterial, Rapid Infusion Chemotherapy for External Auditory Canal Cartinoma,” The Journal of Laryngology & Otology, Vol. 123, No. S31, 2009, pp. 75-80. http://dx.doi.org/10.1017/S0022215109005143
[17]	J. E. Medina, A. O. Park, G. L. Neely, et al., “Lateral Temporal Bone Resection,” American Journal of Surgery, Vol. 160, No. 4, 1990, pp. 427-433. http://dx.doi.org/10.1016/S0002-9610(05)80559-8
[18]	R. T. Sataloff, D. L. Myers, L. D. Lowry and J. R. Spiegel, “Total Temporal Resection for Squamous Cell Carcinoma,” Otolaryngology-Head and Neck Surgery, Vol. 96, No. 1, 1987, pp. 4-14.
[19]	M. Ito, M. Hatano and T. Yoshizaki, “Prognostic Factors for Squamous Cell Carcinoma of the Temporal Bone: Extensive Bone Involvement or Extensive Soft Tissue Involvement?” ActaOto-Laryngologica, Vol. 129, No. 11, 2009, pp. 131-139. http://dx.doi.org/10.3109/00016480802642096
[20]	S. Prasad and I. P. Janecka, “Efficacy of Surgical Treatments for Squamous Cell Carcinoma of the Temporal Bone: A Literature Review,” Otolaryngology-Head and Neck Surgery, Vol. 110, No. 3, 1994, pp. 270-280. http://dx.doi.org/10.1016/S0194-5998(94)70769-3