Long-term survival after immunotherapy for uncontrolled locally advanced temporal bone squamous cell carcinoma followed by chemoradiotherapy: A case report

Abstract

Temporal bone squamous cell carcinoma (TBSCC) is a rare and invasive malignant tumor. The common predisposing factors include a history of local radiotherapy and chronic suppurative otitis media. The current treatment approach for TBSCC primarily involves surgery, followed by adjuvant radiotherapy and chemotherapy, based on T staging and high-risk factors. Although patients with early-stage TBSCC have a high survival rate after treatment, the majority of patients are diagnosed in the intermediate to advanced stages, with extensive tumor involvement, posing challenges for surgical intervention. Definitive chemoradiotherapy (CRT) serves as a viable alternative for unresectable tumors. Constraints in administering curative radiation doses, due to the tolerance of surrounding organs, can lead to uncontrolled tumor growth. Although programmed cell death 1 inhibitors have demonstrated efficacy in head and neck squamous cell carcinoma and cutaneous squamous cell carcinoma, their application in TBSCC remains underexplored. Herein, we report a case of a 47-year-old man diagnosed with unresectable advanced and localized TBSCC. Following inadequate tumor control with primary chemoradiotherapy, immunotherapy was initiated, resulting in disease remission within a follow-up period of > 4 years.

Keywords

immunotherapy / radiotherapy / temporal bone malignancy

References

[1] ArenaS, KeenM. Carcinoma of the Middle Ear and Temporal Bone. Am J Otol. 1988;9(5):351-356.

[2] KuhelWI, HumeCR, SelesnickSH. Cancer of the external auditory canal and temporal bone. Otolaryngol Clin North Am. 1996;29(5):827-852.

[3] MoodySA, HirschBE, MyersEN. Squamous cell carcinoma of the external auditory canal: an evaluation of a staging system. Am J Otol. 2000;21(4):582-588.

[4] PrasadSC, D'Orazio F, MedinaM, BacciuA, SannaM. State of the art in temporal bone malignancies. Curr Opin Otolaryngol Head Neck Surg. 2014;22(2):154-165.

[5] BacciuA, Clemente IA, PiccirilloE, FerrariS, SannaM. Guidelines for treating temporal bone carcinoma based on long-term outcomes. Otol Neurotol. 2013;34(5):898-907.

[6] GidleyPW, DeMonte F. Temporal bone malignancies. Neurosurg Clin N Am. 2013;24(1):97-110.

[7] LionelloM, Stritoni P, FaccioloMC, et al. Temporal bone carcinoma. Current diagnostic, therapeutic, and prognostic concepts. J Surg Oncol. 2014;110(4):383-392.

[8] MastersonL, Rouhani M, DonnellyNP, et al. Squamous cell carcinoma of the temporal bone: clinical outcomes from radical surgery and postoperative radiotherapy. Otol Neurotol. 2014;35(3):501-508.

[9] SioufiK, HaynesAD, GidleyPW, Maniakas A, RobertsD, NaderME. Survival Outcomes of Temporal Bone Squamous Cell Carcinoma: a Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg. 2024. Published online February 11, 2024.

[10] MatobaT, HanaiN, SuzukiH, et al. Treatment and Outcomes of Carcinoma of the External and Middle Ear: the Validity of En Bloc Resection for Advanced Tumor. Neurol Med Chir (Tokyo). 2018;58(1):32-38.

[11] MehtaGU, Muelleman TJ, BrackmannDE, GidleyPW. Temporal bone resection for lateral skull-base malignancies. J Neurooncol. 2020;150(3):437-444.

[12] LeonettiJP, SmithPG, KletzkerGR, Izquierdo R. Invasion patterns of advanced temporal bone malignancies. Am J Otol. 1996;17(3):438-442.

[13] NaganoT, Yoshimura RI, KojimaM, NakagawaK, TodaK. Outcomes of radiotherapy in advanced external auditory canal cancer. J Radiat Res. 2019;60(3):380-386.

[14] ShigaK, Katagiri K, SaitohD, OgawaT, Higashi K, ArigaH. Long-Term Outcomes of Patients with Squamous Cell Carcinoma of the Temporal Bone after Concomitant Chemoradiotherapy. J Neurol Surg B Skull Base. 2018;79(4):S316-S321. Suppl.

[15] MastersonL, Rouhani M, DonnellyNP, et al. Squamous cell carcinoma of the temporal bone: clinical outcomes from radical surgery and postoperative radiotherapy. Otol Neurotol. 2014;35(3):501-508.

[16] PfreundnerL, Schwager K, WillnerJ, et al. Carcinoma of the external auditory canal and middle ear. Int J Radiat Oncol Biol Phys. 1999;44(4):777-788.

[17] PrabhuR, Hinerman RW, IndelicatoDJ, et al. Squamous cell carcinoma of the external auditory canal: long-term clinical outcomes using surgery and external-beam radiotherapy. Am J Clin Oncol. 2009;32(4):401-404.

[18] HashiN, Shirato H, OmatsuT, et al. The role of radiotherapy in treating squamous cell carcinoma of the external auditory canal, especially in early stages of disease. Radiother Oncol. 2000;56(2):221-225.

[19] HsiaoKY, YehSA, ChangCC, Tsai PC, WuJM, GauJS. Cognitive function before and after intensity-modulated radiation therapy in patients with nasopharyngeal carcinoma: a prospective study. Int J Radiat Oncol Biol Phys. 2010;77(3):722-726.

[20] HarringtonKJ, FerrisRL. Nivolumab versus standard, single-agent therapy of investigator's choice in recurrent or metastatic squamous cell carcinoma of the head and neck (CheckMate 141): health-related quality-of-life results from a randomised, phase 3 trial. Lancet Oncol. 2017;18(8):1104-1115.

[21] SeiwertTY, Burtness B, MehraR, et al. Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012): an open-label, multicentre, phase 1b trial. Lancet Oncol. 2016;17(7):956-965.

[22] BurtnessB, Harrington KJ, GreilR, et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study [published correction appears in Lancet. 2020 Jan 25;395(10220):272] [published correction appears in Lancet. 2020 Feb 22;395(10224):564] [published correction appears in Lancet. 2021 Jun 12;397(10291):2252]. Lancet. 2019;394(10212):1915-1928.

[23] ChenA, AliN, BoasbergP, Ho AS. Clinical Remission of Cutaneous Squamous Cell Carcinoma of the Auricle with Cetuximab and Nivolumab. J Clin Med. 2018;7(1):10.

[24] RavulapatiS, LeungC, PoddarN, Tu Y. Immunotherapy in Squamous Cell Skin Carcinoma: a Game Changer?Am J Med. 2017;130(5):e207-e208.

[25] DegacheE, Crochet J, SimonN, et al. Major response to pembrolizumab in two patients with locally advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol. 2018;32(7):e257-e258.

RIGHTS & PERMISSIONS

2024 2024 The Author(s). Precision Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Shandong Cancer Hospital & Institute.