颞骨鳞癌33例远期疗效分析

目的 评价乳突根治术加手术前或手术后放射治疗颞骨鳞癌的疗效。方法 回顾性分析３３例颞骨鳞吕治疗的远期疗效。根据病变范围分为３个亚组：鳞癌局限于外耳道３例（Ⅰ组））；病变侵及中耳乳突腔１７例（Ⅱ组）；更晚期病变１３例（Ⅲ组）。治疗方式分为：手术２例，放射治疗１１例，综合治疗（手术加术前或术后放射治疗）２０例。手术采用乳突根治术１９例，外耳道局部切除２例，颞骨次全切除１例；放射治疗剂量３５００￣１００

Squamous cell carcinoma of temporal bone: an analysis of long-term treatment results in 33 patients]

OBJECTIVE: To evaluate the long-term results in patients with squamous cell carcinoma of the temporal bone and treated by of mastoidectomy combined with perioperative radiation therapy. METHODS: Thirty-three patients with squamous cell carcinoma invading the temporal bone were reviewed retrospectively. According to the tumor extent, the patients were staged into three subgroups, 3 with lesions confined to the auditory canal(Group I), 17 with involvement of the middle ear or mastoid(Group II) and 13 with more extensive disease(Group III). Two patients were treated by surgery, 11 by irradiation and the remaining 20 by the combined surgery and perioperative radiotherapy. The surgical procedures included sleeve resection for group I patients, mastoidectomy for all other patients except one who had subtotal temporal bone resection. The radiation doses were in the range of 3,500 to 10,000 cGy, with an average dose of 6,560 cGy. RESULTS: The 5-year survival rate for the whole series was 51.7% by the life table analysis. The estimated 5-year survival rates for 3 subgroups were 100%, 68.8%, and 19.6%, respectively (P = 0.012). Radiation alone had a 28.7% survival rate and combined therapy 59.6% (P = 0.80). For patients treated with planned combined therapy, the actual 5-year survival rates were 72.7% (8/11) for Group II and 12.5% (1/8) for Group III (P = 0.02). Twelve patients died of local recurrence (10 cases), cervical metastases(1 case) and liver metastases (1 case) with 67.0% (8/12) succumbed to their diseases within two years. Complications included osteonecrosis (n = 1), osteitis (n = 3), radiation dermatitis (n = 2), facial palsy (n = 2), and delayed healing (n = 2). CONCLUSION: The 5-year survival rates in patients with mastoidectomy with removal of gross tumor, combined with planned perioperative irradiation therapy, are similar or higher than those from literature. This protocol can be used in patients with squamous cell carcinoma confined to the middle ear or the mastoid.