Survival Outcomes of Temporal Bone Squamous Cell Carcinoma: Systematic Review

Introduction: Temporal bone squamous cell carcinoma (TBSCC) is a rare head and neck malignancy with a poor prognosis. It remains unclear as to which treatment modality provides the best survival outcome for advanced disease. Our objective was to perform a systematic review of the literature and evaluate the survival outcomes of advanced TBSCC according to treatment modality.

Methods: A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EMBASE, Medline, PubMed, and Web of Science were reviewed for articles published between January 1989 and September 2022 to identify studies evaluating the 5-year survival outcomes of TBSCC following curative intent treatment.

Results: The review yielded 1184 citations of which 49 focused on TBSCC, and 38 provided 5-year survival data. From these selected studies, 1534 patients with TBSCC were included in the final analysis. T classification data was available for 1532 patients (T1: 215, T2:238, T3: 362, T4:717) and overall stage for 1107 patients (Stage 1: 138, stage 2: 146, stage 3: 207, stage 4: 616). Lymph node metastasis was found in 18%. Data for 5-year overall survival (OS) rate was available for 635 patients and was found to be 59.3%. Five-year OS was 85% for T1/2 and 44% for T3/4 cancers (p < 0.0001). For T1/T2 cancers, OS did not significantly differ between patients treated by surgery vs radiation (p=1.0000). For advanced-staged disease (T3/T4), there was no significant difference in OS when comparing 1) surgery with adjuvant chemoradiotherapy (Surg+CRT) vs. definitive CRT alone (53% vs 61%, respectively, p=0.4418), 2) surgery with radiotherapy (Surg+XRT) vs. definitive CRT (57% vs 61%, respectively, p=1.0000), and 3) Surg+CRT vs Surg+XRT (53% vs 57%, respectively, p=1.0000).

Conclusions: This study confirms the prognostic correlation of the current T classification system. Our results suggest that surgery is equivalent to radiation for early-stage disease and that combined treatment modalities confer similar 5-year OS for advanced cancers.