title: Trimodality approach for ceruminous mucoepidermoid carcinoma of the external auditory canal.
abstract: BACKGROUND
  Ceruminous mucoepidermoid carcinoma of the external auditory canal is extremely rare. This paper highlights the impact of concurrent chemoradiotherapy on the outcomes of this disease.
  
  
  METHODS
  A 47-year-old female presented with a 2-month history of otalgia and a mass in her right ear. Biopsy revealed high grade ceruminous mucoepidermoid carcinoma. She underwent surgical excision of the right external auditory canal and right upper neck dissection. Pathological analysis of tumour-node-metastasis staging revealed a T2 N0 (stage II) tumour. One year later, computed tomography scanning of the temporal bone showed tumour recurrence. Biopsy revealed recurrent ceruminous mucoepidermoid carcinoma. The patient underwent salvage resection. Pathology revealed that the tumour was diffusely invading nearby structures, with perineural invasion, lymphatic spread and extracapsular extension. Pathological analysis of tumour-node-metastasis staging revealed a T3 N1 M0 (recurrent stage IV) tumour.
  
  
  RESULTS
  The patient subsequently received concurrent chemoradiotherapy. There was no evidence of disease at 37 months' follow up.
  
  
  CONCLUSIONS
  The trimodality approach, using surgery plus concurrent chemoradiotherapy, provided reasonable loco-regional control with tolerable toxicity. Further detailed case reports are warranted to optimise the management of this rare malignancy.
authors: Department of Radiation Oncology, Beth Israel Medical Center, New York, USA.
authors: W F
authors: WF
authors: Mourad
authors: Department of Radiation Oncology, Beth Israel Medical Center, New York, USA.
authors: K S
authors: KS
authors: Hu
authors: Department of Radiation Oncology, Beth Israel Medical Center, New York, USA.
authors: R A
authors: RA
authors: Shourbaji
authors: Department of Radiation Oncology, Beth Israel Medical Center, New York, USA.
authors: L B
authors: LB
authors: Harrison
mesh_terms: D018277:Carcinoma, Mucoepidermoid / Q000473:pathology / Q000601:surgery*; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods*; D004424:Ear Canal / Q000601:surgery*; D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome