Squamous cell carcinoma of the external auditory canal. Therapeutic prognosis based on a proposed staging system.

OBJECTIVE

To determine the adequacy of the proposed TNM staging system and evaluate the therapeutic modalities used at our institution in an attempt to synthesize guidelines for therapy of primary squamous cell carcinoma (SCC) of the temporal bone.

DESIGN

Case series of 22 patients with previously untreated or residual SCC of the temporal bone treated between 1970 and 1990. Mean follow-up of the surviving patients was 124.5 months (range, 46 to 210 months).

SETTING

University of Texas M. D. Anderson Cancer Center, Houston, an ambulatory and hospitalized care referral center.

PATIENTS

The hospital charts of 41 patients with carcinoma of the temporal bone seen between 1970 and 1990 were retrospectively reviewed. Twenty-two of these patients had previously untreated or residual SCC of the external auditory canal and were chosen for this study. Information was collected regarding symptoms, tumor location, treatment methods, pathologic diagnosis, and patient outcomes.

MAIN OUTCOME MEASURE

Accuracy of proposed staging system in predicting 5-year survival. Effect of surgery alone, radiotherapy alone, and surgery combined with radiotherapy on survival.

RESULTS

Using the Pittsburgh staging system, the conditions of eight patients (36%) were staged at T1, four (18%) were staged at T2, six (27%) were staged at T3, and four (18%) were staged at T4. (The 19 patients with either recurrent disease or non-SCC were also treated, but their conditions were not staged). Statistical validation is impossible owing to the small sample sizes. Combination therapy with surgery and radiotherapy provided a higher 5-year survival rate than surgery or radiotherapy alone. Extrapolation of our data confirms that a staging system is useful in planning therapy. Surgical resection followed by radiotherapy is the preferred treatment for SCCs of the external auditory canal.