Author(s)
Matthew D. Adams, MD
Andrés Gorbea Dolagaray, MD
LeeAnn T. Marcello, BS
Affiliation(s)
SUNY Downstate Health Sciences University
Abstract:
Objective: To elucidate the impact of adjuvant radiotherapy (RT) on overall survival within 12 weeks of lateral temporal bone resection (LTBR), and investigate the rates of complications.
Study design: Retrospective cohort study of the TriNetX database.
Setting: TriNetX is a live HIPAA-compliant federated cloud electronic health record research network representing pooled data from 125-million patients from 69 healthcare organizations in the United States, Taiwan, Japan, Brazil, and India.
Patients: Subjects with temporal bone neoplasms who underwent LTBR. Cohorts were generated by those who did or did not receive adjuvant RT. Patients were matched 1:1 using propensity score matching for medical comorbidities and TNM staging.
Main outcome measure(s): Five-year overall survival; hazard ratio (HR) and risk ratio (RR) with 95% confidence intervals; rates of complications.
Results: 651 patients were identified, 547 patients treated with LTBR alone and 104 treated with LTBR and RT. In the LTBR group, 12 patients developed post-operative meningitis and 27 patients had bone-anchored hearing aid placement. After propensity score matching, 93 patients were identified in each cohort. There was no difference in age or sex between groups. Five-year overall survival was similar between cohorts (65.5% in LTBR alone vs 64.3% in LTBR and RT, HR 0.937, 95% CI 0.527 - 1.668, p = 0.751). There was no increased risk for facial nerve palsy between groups (RR 1.016, 95% CI 0.490 - 2.110). The rates of meningitis, CSF leak, and bone-anchored hearing aid placement were not detectable after propensity-score matching.
Conclusions: This study supports that RT imparts no added overall survival benefit in patients with temporal bone neoplasia undergoing LTBR, and does not increase the risk of facial nerve palsy.
Professional Practice Gap & Educational Need: Evidence guiding adjuvant therapy after LTBR is limited. Clarification of treatment paradigms and their consequences may improve multidisciplinary care.
Learning Objectives: 1. Understand the impact of adjuvant RT following LTBR in a patient-matched, multi-national database study, 2. Learn the rates of associated complications and trends in hearing rehabilitation.
Desired Result: Motivate future studies on the role of adjuvant therapies in lateral temporal bone neoplasia.
Level of Evidence – Level III
Indicate IRB or IACUC: Exempt