title: Primary radical radiotherapy for squamous cell carcinoma of the middle ear and external auditory cana--an historical series.
abstract: OBJECTIVE
  To evaluate patients treated with radical radiotherapy alone for squamous cell carcinoma of the middle ear (MEC) and external auditory canal (EAC) in terms of freedom from local recurrence, cancer-specific survival and morbidity.
  
  
  METHODS
  Between 1965 and 1988, 123 patients were treated, 70 with MEC and 53 with EAC. The median age was 64 years (range 21-86) and 78% presented as late stage. The median dose was 55 Gy (range 39-55) in 16 once daily fractions (range 13-21).
  
  
  RESULTS
  At 5 and 10 years, respectively, freedom from local recurrence was 56 and 56%, disease-free survival was 45 and 43%, cancer-specific survival was 53 and 51%, and overall survival was 40 and 21%. Cancer-specific survival was significantly worse with late stage as opposed to early stage (P = 0.0026), as was local recurrence (P = 0.0088). No differences in survival and local control were seen according to site. Radionecrosis developed in 6% of patients.
  
  
  CONCLUSIONS
  Combined treatment using radiotherapy and radical surgery is often favoured. This large series shows that radical radiotherapy achieves comparable results in terms of local control and cancer-specific survival. Our radiotherapy regimen is now 55 Gy in 20 daily fractions to reduce late morbidity. Radiotherapy alone remains a viable option, especially as morbidity can be minimised and target volume delineation optimised using computer planning in the future.
authors.affiliation: Weston Park Hospital, Sheffield, UK. pembertonlaura@hotmail.com
authors.forename: L S
authors.initials: LS
authors.lastname: Pemberton
authors.forename: R
authors.initials: R
authors.lastname: Swindell
authors.forename: A J
authors.initials: AJ
authors.lastname: Sykes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004424:Ear Canal / Q000528:radiation effects*; D004428:Ear Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D004432:Ear, Middle / Q000528:radiation effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome