Treatment and prognosis of squamous cell carcinoma of the external auditory canal and middle ear: a multi-institutional retrospective review of 87 patients.
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.
Ogawa
Kazuhiko
K
Department of Radiology, University of the Ryukyus, Okinawa, Japan. kogawa@med.u-ryukyu.ac.jp
Nakamura
Katsumasa
K
Hatano
Kazuo
K
Uno
Takashi
T
Fuwa
Nobukazu
N
Itami
Jun
J
Kojya
Shizuo
S
Nakashima
Torahiko
T
Shinhama
Akihiko
A
Nakagawa
Takashi
T
Toita
Takafumi
T
Sakai
Mitsuhiro
M
Kodaira
Takeshi
T
Suzuki
Mikio
M
Ito
Hisao
H
Murayama
Sadayuki
S
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