Squamous cell carcinoma of the external auditory canal and middle ear: An operation combined with preoperative chemoradiotherapy and a free surgical margin
Squamous cell carcinoma of the external auditory canal and middle ear: An operation combined with preoperative chemoradiotherapy and a free surgical margin
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DOI：
10.1097/01.mao.0000190463.88873.3d
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发表时间：
2006-02-01
影响因子：
2.1
通讯作者：
Komune, S
中科院分区：
文献类型：
--
作者：
Nakagawa, T;Kumamoto, Y;Komune, S
目的：颞骨鳞状细胞癌的治疗结果进行了评估阶段，治疗策略和预后factors.Study设计：回顾性病例回顾。设置：大学医院和门诊诊所。患者：25例原发性外耳道和中耳鳞状细胞癌患者。干预：术前放化疗和放疗在12例患者中的7例中使用。病变未超过鼓膜者行侧颞骨切除术。当病变延伸至中耳腔且未侵犯锥尖、颈动脉管、硬脑膜或转移时，选择颞骨次全切除术。其余患者均采用保守治疗。当性能状态差或协议有关的操作无法达成，治疗修改。主要结果Measure：估计生存率。结果：T1和T2病变的3年估计生存率为100%。T3和T4病变的5年估计生存率分别为80%和35%。47个月后，T4肿瘤手术治疗的5年估计生存率提高到75%，未手术治疗的5年估计生存率提高到16%。无肿瘤手术切缘与T3和T4病变患者的生存率显著相关。多因素分析预测，合并慢性中耳炎和阳性淋巴结是显着相关的生存较差。结论：无肿瘤的手术切缘是重要的生存。当T4病变不涉及锥体顶点、颈动脉管、硬脑膜或任何淋巴结时，手术干预将估计的生存率提高到与T3病变一样好的水平。
Objective: Treatment outcomes for squamous cell carcinoma of the temporal bone were evaluated regarding stage, therapeutic strategy, and prognostic factors.Study Design: Retrospective case review.Setting: University hospital and outpatient clinic.Patients: Twenty-five patients with primary squamous cell carcinoma of the external auditory canal and middle ear.Intervention: 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.Main Outcome Measure: 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.Conclusion: 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.