title: [Carcinoma of the external ear canal and middle ear as interdisciplinary challenge for ear surgery and radiotherapy].
abstract: BACKGROUND
  Carcinoma of the external auditory canal are tumours considered to have a poor prognosis. Improvement of the survival rate by surgical means alone is not possible. Individual therapy modalities as a result of an interdisciplinary approach between otosurgeon and radiotherapist are necessary.
  
  
  METHODS
  A series of 30 patients (3 patients pretreated at other institutions) with carcinoma of the external auditory canal and middle ear treated between 1978 and 1997 in our institutions was analysed with particular reference to tumour size and its relation to surrounding tissues, patterns of neck node involvement, surgical procedures, and radiation techniques. Clinical endpoints were freedom from local failure, overall survival, disease-free survival. The mean follow-up was 4.7 years (range: 0.1 to 18.8 years), median 3 years.
  
  
  RESULTS
  Treatment by surgery and radiotherapy resulted in an overall 5-year survival rate of 51%. According to Pittsburgh classification the 5-year survival rate for early disease (T1- and T2-tumours) was 89%, for stage III 67% and for stage IV 39%. Most important prognostic factors were dural infiltration (all patients with dural invasion died within 2.2 years) and the infiltration of surgical margins (the 5-year survival rate of patients with complete tumour resection was 100%, but 54% in patients with tumour beyond surgical margins). 192-iridium HDR afterloading brachytherapy based on 3D CT-treatment planning is an effective tool in the management of local recurrences following surgery and a full course of external beam radiotherapy.
  
  
  CONCLUSIONS
  Surgical resection followed by radiotherapy adapted to the stage of disease and grade of resection is the preferred treatment of cancer of the external auditory canal and middle ear.
authors.affiliation: Klinik und Poliklinik für Hals-, Nasen- und Ohrenkranke der Universität Würzburg. k.schwager@mail.uni-wuerzburg.de
authors.forename: K
authors.initials: K
authors.lastname: Schwager
authors.forename: L
authors.initials: L
authors.lastname: Pfreundner
authors.forename: F
authors.initials: F
authors.lastname: Hoppe
authors.forename: G
authors.initials: G
authors.lastname: Baier
authors.forename: J
authors.initials: J
authors.lastname: Willner
authors.forename: K
authors.initials: K
authors.lastname: Baier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D004424:Ear Canal / Q000601:surgery*; D004428:Ear Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D004432:Ear, Middle / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010348:Patient Care Team; D018714:Radiotherapy, Adjuvant; D011882:Radiotherapy, High-Energy; D015996:Survival Rate