Surgical management of carcinomas of the infratemporal fossa and skull base: patterns of failure and predictors of long-term outcomes

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  • 1 Department of Head and Neck Surgery, Division of Surgery;
  • 2 Department of Pathology;
  • 3 Baylor College of Medicine; and
  • 4 Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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OBJECTIVE

Infratemporal fossa (ITF) tumors are unique in histological characteristics and difficult to treat. Predictors of patient outcomes in this context are not known. The objective of this study was to identify independent predictors of outcome and to characterize patterns of failure in patients with ITF carcinoma.

METHODS

All patients who had been surgically treated for anterolateral skull base malignancy between 1999 and 2017 at the authors’ institution were retrospectively reviewed. Patient demographics, preoperative performance status, tumor stage, tumor characteristics, treatment modalities, and pathological data were collected. Primary outcomes were disease-specific survival (DSS) and local progression-free survival (LPFS) rates. Overall survival (OS) and patterns of progression were secondary outcomes.

RESULTS

Forty ITF malignancies with skull base involvement were classified as carcinoma. Negative margins were achieved in 23 patients (58%). Median DSS and LPFS were 32 and 12 months, respectively. Five-year DSS and OS rates were 55% and 36%, respectively. The 5-year LPFS rate was 69%. The 5-year overall PFS rate was 53%. Disease recurrence was noted in 28% of patients. Age, preoperative performance status, and margin status were statistically significant prognostic factors for DSS. Lower preoperative performance status and positive surgical margins increased the probability of local recurrence.

CONCLUSIONS

The ability to achieve negative margins was significantly associated with improved tumor control rates and DSS. Cranial base surgical approaches must be considered in multimodal treatment regimens for anterolateral skull base carcinomas.

ABBREVIATIONS CN = cranial nerve; DSS = disease-specific survival; ITF = infratemporal fossa; KPS = Karnofsky Performance Status; LPFS = local progression-free survival; OS = overall survival; STF-ITF = subtemporal fossa–ITF.

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Contributor Notes

Correspondence Shaan M. Raza: The University of Texas MD Anderson Cancer Center, Houston, TX. smraza@mdanderson.org.

INCLUDE WHEN CITING Published online June 12, 2020; DOI: 10.3171/2020.3.JNS192630.

Disclosures Dr. Nader has direct stock ownership in Johnson & Johnson, Medtronic, Kimberly Clark, Amgen, 3M, and Pfizer.

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