Carcinoma of the external auditory canal and middle ear

Purpose: To evaluate therapeutic modalities used at our institutions regard ing local control, disease-free survival and actuarial survival in carcinom a of the external auditory canal and middle ear, in an attempt to provide g uidelines for therapy. Methods and Materials: A series of 27 patients with carcinoma of the extern al auditory canal and middle ear treated between 1978 and 1997 in our insti tutions were analyzed with particular reference to tumor size and its relat ion to surrounding tissues, patterns of neck node involvement, surgical pro cedures, and radiation techniques employed. Clinical endpoints were freedom from local failure, overall survival, and disease-free survival. The media n follow-up was 2.7 years (range 0.1-17.9 years). Results: Treatment by surgery and radiotherapy resulted in an overall 5-yea r survival rate of 61%. According to the Pittsburgh classification, the act uarial 5-year survival rate for early disease (T1-and T2 tumors) was 86%, f or T3 tumors 50%, and T4 stages 41%. Patients with tumors limited to the ex ternal auditory canal had a 5-year survival rate of 100%, patients with tum or invasion of the temporal bone 63%, and patients with tumor infiltration beyond the temporal bone 38%. The rate of freedom from local recurrence was 50% at 5 years. Unresectability by dural and cerebral infiltration, and tr eatment factors such as complete resection or resection with tumor beyond s urgical margins are of prognostic relevance. All patients with dural invasi on died within 2.2 years. The actuarial 5-year survival rate of patients wi th complete tumor resection was 100%, but 66% in patients with tumor beyond surgical margins. (192)Iridium high-dose-rate (HDR) afterloading brachythe rapy based on three-dimensional computed tomography (3D CT)-treatment plann ing was an effective tool in man agement of local recurrences following sur gery and a full course of external beam radiotherapy. Conclusion: Surgical resection followed by radiotherapy adapted to stage of disease and grade of resection is the preferred treatment of cancer of the external auditory canal and middle ear. (C) 1999 Elsevier Science Inc.