Lambert Elton M, Garden Adam S, DeMonte Franco, Roberts Dianna B, Gidley Paul W
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1445, Houston, Texas, U.S.A.
Laryngoscope. 2015 May;125(5):1198-204. doi: 10.1002/lary.25071. Epub 2014 Dec 4.
OBJECTIVES/HYPOTHESIS: To examine our experience with surgically treated radiation-associated malignancy (RAM) of the temporal bone.
Retrospective chart review.
Thirteen patients treated surgically for temporal-bone RAM during 1999 to 2012 were identified. Demographics, symptoms at presentation with RAM, interval between initial radiotherapy and diagnosis of RAM, pathologic features of RAM, treatment, and recurrence and survival were obtained from medical records.
Ten patients had squamous cell carcinoma; three had sarcoma. The mean period between completion of radiotherapy and diagnosis of RAM was 13.38 years (range, 4.5-33.3 years). Three-year overall and disease-free survival rates were 59.8% and 42.3%, respectively. Seven patients (54%) had RAM limited to the external auditory canal (LEAC); six had RAM extending beyond it (EEAC). The mean age was 66.5 years for LEAC patients versus 41.1 years for EEAC patients (P = .0161). Compared to patients with EEAC disease, patients with LEAC disease were more likely to have negative margins (100% vs. 33%; P = .021) and less likely to have postoperative adjuvant therapy (0% vs. 67%; P = .0209). The 3-year disease-specific survival was significantly better for patients with LEAC disease versus EEAC (log rank P = .023).
To our knowledge, this is the largest reported series of surgically treated RAM of the ear canal or temporal bone. This study highlights the need for vigilance for RAM in patients treated with head and neck radiation.
目的/假设：研究我们手术治疗颞骨放射性相关恶性肿瘤（RAM）的经验。
回顾性病历审查。
确定了1999年至2012年间接受手术治疗颞骨RAM的13例患者。从医疗记录中获取人口统计学资料、RAM出现时的症状、初始放疗与RAM诊断之间的间隔、RAM的病理特征、治疗以及复发和生存情况。
10例患者为鳞状细胞癌；3例为肉瘤。放疗结束至RAM诊断的平均时间为13.38年（范围4.5 - 33.3年）。三年总生存率和无病生存率分别为59.8%和42.3%。7例患者（54%）的RAM局限于外耳道（LEAC）；6例患者的RAM超出外耳道（EEAC）。LEAC患者的平均年龄为66.5岁，而EEAC患者为41.1岁（P = 0.0161）。与EEAC疾病患者相比，LEAC疾病患者更有可能切缘阴性（100%对33%；P = 0.021），且接受术后辅助治疗的可能性更小（0%对67%；P = 0.0209）。LEAC疾病患者的3年疾病特异性生存率明显优于EEAC患者（对数秩检验P = 0.023）。
据我们所知，这是报道的最大系列手术治疗耳道或颞骨RAM的病例。本研究强调对头颈部放疗患者的RAM需保持警惕。
4。《喉镜》，125:1198 - 1204，2015年。
