title: Neoadjuvant chemotherapy in technically unresectable carcinoma of external auditory canal.
abstract: BACKGROUND
  Carcinoma of external auditory canal (EAC) is a very rare malignancy with surgical resection as the main modality of treatment. The outcomes with nonsurgical modalities are very dismal. We present a retrospective analysis of 4 patients evaluating the role of neoadjuvant chemotherapy in technically unresectable cancers.
  
  
  METHODS
  This is a retrospective analysis of 4 patients from our institute from 2010 to 2014 with carcinoma EAC who were deemed unfit for surgery due to extensive disease involving occipital bone with soft tissue infiltration (n = 2), temporal dura (n = 1), left temporal lobe, and extensive soft tissue involvement (n = 1). All these patients received neoadjuvant chemotherapy with docetaxel, cisplatin and 5 fluorouracil (n = 3) and paclitaxel and cisplatin (n = 1).
  
  
  RESULTS
  Response evaluation showed a partial response (PR) in 3 and stable disease (SD) in 1 patient by Response Evaluation Criteria in Solid Tumors criteria. All 3 patients who received 3 drug chemotherapy had PR while 1 patient who received 2 drug chemotherapy had SD. Two of these patients underwent surgery, and other 2 underwent definitive chemoradiation. One of 3 patients who achieved PR underwent surgical resection; the other 2 remained unresectable in view of the persistent intradural extension and infratemporal fossa involvement. One patient who had SD could undergo surgery in view of clearance of infraatemporal fossa. Recent follow-up shows that 3 out of these 4 patients are alive.
  
  
  CONCLUSIONS
  This indicates that there may be a role of induction chemotherapy in converting potentially unresectable tumors to resectable disease that could produce better outcomes in carcinoma EAC.
authors: Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Amit
authors: A
authors: Joshi
authors: Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Nidhi
authors: N
authors: Tandon
authors: Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Vanita
authors: V
authors: Noronha
authors: Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Sachin
authors: S
authors: Dhumal
authors: Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Vijay
authors: V
authors: Patil
authors: Department of Radiology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Supreeta
authors: S
authors: Arya
authors: Department of Radiology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Shashikant
authors: S
authors: Juvekar
authors: Department of Radio-diagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Jaiprakash
authors: J
authors: Agarwal
authors: Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Anil
authors: A
authors: DCruz
authors: Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Prathmesh
authors: P
authors: Pai
authors: Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India.
authors: Kumar
authors: K
authors: Prabhash
keywords: Carcinoma of external auditory canal; neoadjuvant chemotherapy; unresectable