Learning Objectives:

Objective: We aimed to evaluate the prognostic factors and efficacy of treatment modalities for patients with temporal bone cancer, and to determine if definitive chemoradiotherapy (CRT) for advanced-stage disease can provide a substitute for highly invasive surgeries.

Methods: We performed a retrospective, single-institution review of 66 patients with previously-untreated squamous cell carcinoma of the temporal bone treated with curative intent between April 1997 and March 2015. Lateral temporal bone resection was selected as the initial choice of treatment for patients with T1–2 tumors. If histologic examination revealed positive surgical margins or more extensive involvement than preoperative imaging suggested, postoperative radiotherapy (RT) or CRT was performed. For patients with T3–4, lateral or subtotal temporal bone resection was performed. Adjuvant RT or CRT for T3–4 disease was systematically proposed after surgical resection. For locally advanced tumors with extension to the pyramidal apex, posterior cranial fossa, middle cranial fossa or internal carotid artery, definitive CRT or RT was also selected.

Results: The 5-year overall survival (OS) rate for each T classification was 100% for T1, 76.2% for T2, 55.6% for T3 and 36.7% for T4. Univariate and multivariate analysis showed that T classification was an independent predictor of the OS rate (hazard ratio 5.64; 95% confidence interval 1.34–23.8; p = 0.0184). Analysis by treatment modality revealed that the 5-year OS rate for patients with T1–2 was 100% for surgery and 81.3% for RT alone. The rate for patients with T3–4 was 52.1% for definitive CRT and 55.6% for surgery followed by RT with or without chemotherapy.

Conclusions: Patients with T1–2 benefited from surgical intervention without significant morbidity or mortality. Our findings also suggested that definitive CRT might be appropriate as the first-line treatment for T3–4, especially in cases with unresectable tumors.