Outcomes of Temporal Bone Resection for Locally Advanced Parotid Cancer

Objective: The purpose of this study is to report outcomes and identify factors predictive of survival and recurrence, in patients undergoing lateral temporal bone resection (LTBR) as part of an extended radical parotidectomy for de novo and recurrent primary parotid cancer. Methods: Retrospective analysis was performed of patients undergoing LTBR for locally advanced parotid cancer between 1994 and 2010 at Memorial Sloan-Kettering Cancer Center and New York Presbyterian Hospital-Weill Cornell Medical College. Survival and recurrence were analyzed using the Kaplan-Meier method and Cox multivariable regression. Results: Twelve patients with a median follow-up of 30.6 months were included: 6 de novo cases and 6 patients referred after local recurrence. Four cases were carcinomas ex pleomorphic adenoma. Following radical parotidectomy with LTBR, 11 patients received postoperative radiation and 2 received chemoradiation. Three patients had major complications, and facial nerve function was preserved in one patient. Locoregional control at 2 years was 73%. However, most patients (11; 92%) ultimately developed disease recurrence, with distant metastases the most common (83%) site of first failure. Overall and disease-specific survival were 80% at 2 years and 22.5% at 5 years. Recurrence-free survival was 67% at 2 years, and 8.3% at 5 years. On multivariate analysis, both medical comorbidity ( P = 0.006) and surgical margin status ( P = 0.01) were independent predictors of RFS. Conclusions: In advanced parotid cancer, LTBR with a goal of gross total resection offers reasonable locoregional control with a low incidence of complications. However, the benefits of this surgery must be balanced against surgical morbidity, as well as the low likelihood of long-term survival, with most patients ultimately experiencing distant failure.