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The problem of nodal disease in squamous cell carcinoma of the temporal bone
Elisabetta Zanoletti1, Giovanni Danesi
1ENT Department and Microsurgery of the Skull Base Department, Ospedali Riuniti, Bergamo, Italy. elisabetta.zanoletti@tiscali.it
Conclusion:
The prognosis of the clinically positive neck in temporal bone squamous cell carcinoma is bad and failures never occur in the neck but at the site of the primary. A clinically positive neck at presentation is a sign of aggressiveness of the primary and, in such cases, therapeutic neck dissection is to be performed. The role of elective neck dissection is partially supported by our results, but as prognosis worsens and survival drops when a positive node appears in the neck, elective dissection is still advocated. In our material, no recurrence was recorded in the neck, but it was the resection of the primary tumor that proved to be oncologically inadequate. This led to the conclusion that in cases of clinically positive necks a more extended and adequate approach to the primary is thus advocated.
Objective:
This work aimed to determine the prognostic role of positive neck nodes in squamous cell carcinoma of the temporal bone.
Methods:
We studied the homogeneous case material of 47 surgical cases of temporal bone squamous cell carcinoma, operated on between the years 1983 and 2004. All the cases were reviewed retrospectively, staged according to the Pittsburgh classification, and the follow-up was updated at June 2008 with MRI. The minimum follow-up was set at 3 years.
Results:
All the cases but two were treated with therapeutic or elective neck dissection. The neck was assessed both clinically and pathologically. The cases with clinically positive neck nodes at presentation had unfavorable prognosis. All the failures recurred at the site of the primary and never in the neck. The comparison of outcomes between the cases with clinically positive and negative necks showed a difference in survival. The rate of micrometastasis in the clinically negative neck was investigated as well. Our results indicate that though the necessity of elective neck dissection is still controversial, the bad prognostic value of the clinically positive neck is such to support the indication to treat the clinically negative neck.
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