TREATMENT AND OUTCOMES OF CARCINOMA OF THE

EXTERNAL AND MIDDLE EAR: THE VALIDITY OF EN BLOC

RESECTION FOR ADVANCED TUMOR

TAKUMA MATOBA, NOBUHIRO HANAI, HIDENORI SUZUKI, DAISUKE NISHIKAWA, EIJI TACHIBANA, TAKESHI
OKADA, SHINGO MURAKAMI, AND YASUHISA HASEGAWA

Journal Reading
Tita Puspitasari

Supervisor : Dr. Lina Lasminingrum, dr. SpTHT-KL (K)

DEPT OF OTORHINOLARYNGOLOGY – HNS

SCHOOL OF MEDICINE PADJADJARAN UNIVERSITY
BANDUNG
2019
INTRODUCTION
• Carcinoma of the temporal bone is extremely
rare
• 1–6 cases per 1 million people yearly
• Carcinoma external and middle ear is much rarer
• Limited literatur
• Squamous cell carcinoma (SCC),
adenocarcinoma, adenoid cystic carcinoma,
basal cell carcinoma, melanoma, and various
types of sarcoma
• Decision-making treatment : Account various
clinical behavior clinical courses
• Subtotal temporal resection severe
complications deafness and abolition of the
equilibrium function.
• Radiotherapy alternative
THE PITTSBURGH STAGING

• Since 1990,
• The most recent version
• Has been proven to be trusted and reproducible.
On the basis of this staging system
UNIVERSITY OF PITTSBURGH TNM STAGING SYSTEM
PROPOSED FOR THE EXTERNAL AUDITORY CANAL

T Status
T1: limited CAE, bony erosion or evidence of soft-tissue (-)
T2: limited CAE bone erosion (not full thickness) or limited
(< 0.5 cm) soft-tissue involvement
T3: eroding CAE (full thickness) with limited (< 0.5 cm) soft-
tissue involvement or tumor involving the middle ear and/or
mastoid
T4 : eroding the cochlea, petrous apex, medial wall of the
middle ear, carotid canal, jugular foramen, or dura, or with
extensive soft-tissue involvement of the temporomandibular
joint or styloid process, or evidence of facial paresis

Pablo Martinez-Devesa, Martyn L. Barnes, Chris A. Milford. 2008. Malignant Tumors of the Ear and Temporal
Bone: A Study of 27 Patients and Review of Their Management. SKULL BASE/VOLUME 18, NUMBER 1
 N Status
Involvement of lymph node metastases is a poor
prognosis finding; any node involvement should
automatically be considered as advanced disease
(i.e., T1N1 = stage III and T2, T3, T4, N1 = stage IV).
M Status
Distant metastases indicate a very poor prognosis
and should be considered as stage IV disease.

Pablo Martinez-Devesa, Martyn L. Barnes, Chris A. Milford. 2008. Malignant Tumors of the Ear and Temporal
Bone: A Study of 27 Patients and Review of Their Management. SKULL BASE/VOLUME 18, NUMBER 1
MATERIALS AND METHODS
• A patient database at Aichi Cancer Center Hospital
was treated for carcinoma of the external and middle
• January 1999 - December 2014 → 25 patient.
• Reviewed : Symptoms, histopathology, stages.
• All surgical procedures : en bloc resection.
• Subtotal temporal bone resection = T4 or aggressive
T3 tumors (e.g. tumor invasion near the cochlea,
petrous apex, or carotid canal) without distant
metastasis.
• Distant metastasis CT and PET (except for 2
patients in 1999 ).

Contraindications surgery :

• Wide involvement dura mater or temporal lobe

(cranial limit).

• Invasion posterior fossa, sigmoid sinus (posterior

limit).
• Invasion into the sigmoid sinus → angiography.

• Partial resection sigmoid sinus if we considered en

bloc resection to be possible.

• Not set an anterior limit, instead combined resection

of the temporomandibular joint/total parotidectomy.

• Avoided subtotal temporal bone resection in patients

with severe comorbidities.
• Association parameters - survival → Pearson’s
chi-square test.

• Survival : Time first visit → last confirmation

date / date of death.

• Disease - free survival : Begin treatment → first

recurrence / the date of death.
RESULTS
STAGE IV
• 1 stage IV : surgery + postoperative radiotherapy.
• 7 (50%) → radiotherapy, carbon ion in 2 patients. The
median dose was 70.0 Gy (range: 35.0–70.4 Gy).
• 2 (14%) Palliative chemotherapy.
• 2 Cycles of docetaxel 60 mg/m2 intravenously / 3
weeks.
• Local recurrence internal carotid artery → 8 cycles
of paclitaxel 100 mg/m2 iv every week.
• 2 Recurrent after local resection and postoperative
radiotherapy.
• 1 Multiple lung metastases
Kemungkinan kelangsungan hidup selama 2 tahun pada keseluruhan pasien
dan pasien dengan Stadium IV

75,8 % 67,7 %
Kemungkinan kelangsungan hidup selama 2 tahun pada keseluruhan pasien
yang mendapatkan terapi pembedahan dan radioterapi

80 % 53,6 %
Kemungkinan 2 tahun bebas penyakit pada keseluruhan pasien dan pasien
dengan Stadium IV

57,8 % 42,9 %
Kemungkinan kelangsungan hidup selama 2 tahun pada pasien stadium IV
yang mendapatkan terapi pembedahan dan radioterapi

80 % 28,6 %
Kemungkinan 2 tahun bebas penyakit keseluruhan pasien dan pada pasien
SCC stadium IV yang mendapatkan terapi pembedahan dan radioterapi

75, 62,5 % 75, 33,3 %

DISCUSSION
• Patients treated by radiotherapy tended to have worse
overall and disease-free survival than those who
underwent surgery.

• Previous study : 5-year overall and disease-free survival

rates 37% to 68% and 45%–54%

• Yin et al : 95 cases of SCC of the external and middle ear,

and the 5-year overall survival rate in patients with tumor
stage IV was 29.5%.
• Moody, et al : 32 patients primary SCC external
auditory canal, and the 2-year overall survival rates
were as follows: T1 lesions 100%, T2 80%, T3 50%,
and T4 7%.

• Gandhi, et al : 2-year survival and 2-year progression-

free survival rates of 50.7% and 30.4%.

• Our study : Tumor stage IV, the 2-year overall and 2-

year disease-free survival rates were 67.7% and
42.9%.
CONCLUSION

• en bloc resection suitable as the first choice

for no severe comorbidities even in the
advanced disease stage.
• Further studies with a larger number of
patients and longer follow-up are required to
confirm.
• Furthermore, the treatment outcomes of
patients with unresectable tumor are still
quite poor and should be improved in future
studies.
THANK YOU