Treatment, outcomes, and prognostic factors of ear cancer

Cancer of the ear is rare-and a consensus has not been reached as to the mo st appropriate treatment. In this retrospective study, we examined the trea tment modalities, prognostic factors, and outcomes of patients treated for ear cancer at the National Taiwan University Hospital during a 15-year peri od. The disease-free survival rates of patients with three different diseas e grades were compared using the log-rank test. The effects of prognostic f actors on survival were examined with Cox's proportional hazard model. Of t he 61 ear cancer patients treated from January 1982 through October 1996, 4 7 (36 men, 11 women; mean age, 54.6 yr) had complete records and were inclu ded in this study. The tumor originated from the middle ear in 29 (62%) pat ients and from the external ear canal in 18 (38%). A total of 37 patients u nderwent radical mastoidectomy to remove the gross tumor, while six underwe nt Ride excision of the tumor. Concomitant parotidectomy or neck dissection was performed in seven patients. Thirty-eight patients received postoperat ive radiation therapy and five patients received chemotherapy for palliativ e treatment of recurrent or inoperable tumors. All but four (9 %) of 43 pat ients developed facial nerve palsy postoperatively. There were no deaths di rectly related to surgery or other major complications, including cerebrosp inal fluid leakage, meningitis, or hemiparesis. The 5-year disease-free sur vival rate was 53% overall (n = 47),but differed significantly among patien ts with different grades of disease (p = 0.038): 66% for grade I (n = 27), 44% for grade II (n = 17), and 0% for grade III (n = 3). Multivariate analy sis revealed that cervical lymph node metastasis was a poor prognostic fact or (relative hazard, 16.4; p < 0.001). These results suggest that mastoidec tomy with postoperative radiation therapy can yield satisfactory outcomes, even in some cases of advanced (grade II) disease.