Concomitant chemoradiotherapy as a standard treatment for squamous cell carcinoma of the temporal bone

Abstract

We sought to characterize the effectiveness of concomitant chemoradiotherapy (CCRT) for patients with squamous cell carcinoma of the temporal bone. We performed a retrospective chart review of 14 patients with cancer of the temporal bone who were provided initial treatment in our hospital from December 2001 to November 2008. Four patients with stage I tumors were treated by radiation therapy alone or with oral administration of S1. One patient with a stage II tumor was treated by radiation therapy concomitant with low dose docetaxel. Nine patients with stage IV tumors were treated by CCRT using the TPF regimen (docetaxel, cisplatin, and 5-fluorouracil). As an initial treatment, all patients but one were treated by radiation therapy with or without chemotherapy. Grade 4 adverse events of patients who received CCRT using the TPF regimen involved the leukopenia in one patient and the neutropenia in two patients. Local recurrences were observed in three patients including two patients with T4 tumors. Five-year disease-specific survival rates for all patients and for patients with T4 tumors were 78% and 67%, respectively. CCRT using the TPF regimen is safe and effective as the first treatment for patients with cancer of the temporal bone.

Keywords: Squamous cell carcinoma of the temporal bone; TPF; chemoradiotherapy; survival rates.

Figure 1

Computed tomography findings of case 4. (A) Before treatment; the tumor had invaded into the parapharyngeal space and the parotid gland. (B) In the middle of concomitant chemoradiotherapy; one course of TPF (docetaxel, cisplatin, and 5-fluorouracil regimen) and 40 Gy of radiation therapy had been completed and the tumor had almost disappeared.

Figure 2

Histopathology of the tumor tissue of case 1. (Left) Hematoxylin-eosin staining of the biopsy specimen before treatment. Squamous cell carcinoma cells with keratinization had invaded the interstitial tissues. (Right) Hematoxylin-eosin staining of the surgical specimen after treatment. Carcinoma cells had completely disappeared and hyalinization is observed. It was diagnosed pathologically as a complete response.

Figure 3

Survival curves of the patients. Disease-specific survival rates were calculated by the Kaplan-Meier method. The 5-year survival rate of all patients was 78% (open squares), and of T4 and stage IV patients was 67% (open circles).