title: Treatment and prognosis of squamous cell carcinoma of the external auditory canal and middle ear: a multi-institutional retrospective review of 87 patients.
abstract: OBJECTIVE
  To examine the relative roles of surgery, radiotherapy, and chemotherapy in the management of patients with squamous cell carcinomas of the external auditory canal and middle ear.
  
  
  METHODS
  The records of 87 patients with histologically confirmed squamous cell carcinoma who were treated between 1984 and 2005 were reviewed. Fifty-three patients (61%) were treated with surgery and radiotherapy (S + RT group) and the remaining 34 patients with radiotherapy alone (RT group). Chemotherapy was administered in 34 patients (39%).
  
  
  RESULTS
  The 5-year actuarial overall and disease-free survival (DFS) rates for all patients were 55% and 54%, respectively. On univariate analysis, T stage (Stell's classification), treatment modality, and Karnofsky performance status had significant impact on DFS. On multivariate analysis, T stage and treatment modality were significant prognostic factors. Chemotherapy did not influence DFS. The 5-year DFS rate in T1, T2, and T3 patients was 83%, 45%, and 0 in the RT group (p < 0.0001) and 75%, 75%, and 46% in the S + RT group (p = 0.13), respectively. The 5-year DFS rate in patients with negative surgical margins, those with positive margins, and those with macroscopic residual disease was 83%, 55%, and 38%, respectively (p = 0.007).
  
  
  CONCLUSIONS
  Radical radiotherapy is the treatment of choice for early-stage (T1) diseases, whereas surgery (negative surgical margins if possible) with radiotherapy is recommended as the standard care for advanced (T2-3) disease. Further clarification on the role of chemotherapy is necessary.
authors: Department of Radiology, University of the Ryukyus, Okinawa, Japan. kogawa@med.u-ryukyu.ac.jp
authors: Kazuhiko
authors: K
authors: Ogawa
authors: Katsumasa
authors: K
authors: Nakamura
authors: Kazuo
authors: K
authors: Hatano
authors: Takashi
authors: T
authors: Uno
authors: Nobukazu
authors: N
authors: Fuwa
authors: Jun
authors: J
authors: Itami
authors: Shizuo
authors: S
authors: Kojya
authors: Torahiko
authors: T
authors: Nakashima
authors: Akihiko
authors: A
authors: Shinhama
authors: Takashi
authors: T
authors: Nakagawa
authors: Takafumi
authors: T
authors: Toita
authors: Mitsuhiro
authors: M
authors: Sakai
authors: Takeshi
authors: T
authors: Kodaira
authors: Mikio
authors: M
authors: Suzuki
authors: Hisao
authors: H
authors: Ito
authors: Sadayuki
authors: S
authors: Murayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D004424:Ear Canal; D004428:Ear Neoplasms / Q000401:mortality / Q000628:therapy*; D004432:Ear, Middle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011879:Radiotherapy Dosage; D012062:Relative Biological Effectiveness; D012189:Retrospective Studies