Introduction
Temporal bone cancers account for around 0.2% of head and neck
malignancies and squamous cell carcinoma (SCC) represents the commonest
histopathological subtype (1).
Despite its low incidence, temporal bone squamous cell carcinomas
(TBSCC) are aggressive with poor survival outcomes and high morbidity.
Patients usually present with a troublesome discharging ear, hearing
loss, pain, head and neck lumps and not infrequently a facial palsy(2).
A combination of biopsies and CT as well as MRI imaging is essential to
investigate, diagnose and stage the disease for treatment options.
Although there is no Union for International Cancer Control (UICC) or
American Joint Committee on Cancer Control (AJCC) on TBSCC, the modified
Pittsburgh staging is commonly employed(3).
TBSCC tend to spread locally rather than metastasize to regional lymph
nodes or distant sites, making radical resection of the primary lesion
the mainstay of treatment. Therefore, while neck dissections (ND) are
generally advocated in the presence of nodal disease, although survival
of patients with neck metastases is very poor(4), its role in a
clinically N0 neck (cN0) has been a subject of debate, mainly due to the
lack of evidence and because many units will routinely treat at least
the upper neck as well as the primary site with adjuvant radiotherapy.
The UK national multidisciplinary guidelines on the management of head
and neck cancer(5, 6) have recommended that all TBSCC with cN0 undergo
neck dissection of levels 2-5 based on Rinaldo et al.’s narrative
review, which estimated that the risk of occult metastases lies between
17-25%.(7) Others may decide on the extent of neck dissection based on
the clinical staging, or on performing no neck dissection given that
radiotherapy may be planned post-operatively to the neck.
With these discrepancies in mind, the aim of this systematic review and
meta-analysis is to estimate the rate of occult cervical metastasis in
primary TBSSC and to analyse the evidence on the indication and extent
of elective neck dissection in these tumours.