Carcinoma of the external auditory canal and middle ear as an interdisciplinary challenge for otosurgery and radiotherapy.

Carcinoma of the External Auditory Canal and Middle Ear as an Interdiscipli nary Challenge for Otosurgery and Radiotherapy. Background: Carcinoma of th e external auditory canal are tumours considered to have a poor prognosis. Improvement of the survival rate by surgical means alone is not possible. I ndividual therapy modalities as a result of an interdisciplinary approach b etween otosurgeon and radiotherapist are necessary. Patients and Methods: A series of 30 patients (3 patients pretreated at other institutions) with c arcinoma of the external auditory canal and middle ear treated between 1978 and 1997 in our institutions was analysed with particular reference to tum our size and its relation to surrounding tissues, patterns of neck node inv olvement, surgical procedures, and radiation techniques. Clinical endpoints were freedom from local failure, overall survival, disease-free survival. The mean follow-up was 4.7 years (range: 0.1 to 18.8 years), median 3 years . Results: Treatment by surgery and radiotherapy resulted in an overall 5-y ear survival rate of 51%. According to Pittsburgh classification the 5-year survival rate for early disease (T1- and T2-tumours) was 89%, for stage II I 67% and for stage IV 39%. Most important prognostic factors were dural in filtration (all patients with dural invasion died within 2.2 years) and the infiltration of surgical margins (the 5-year survival rate of patients wit h complete tumour resection was 100%, but 54% in patients with tumour beyon d surgical margins). 192-iridium HDR afterloading brachytherapy, based on 3 D CT-treatment planning is an effective tool in the management of local rec urrences following surgery and a full course of external beam radiotherapy. Conclusions: Surgical resection followed by radiotherapy adapted to the st age of disease and grade of resection is the preferred treatment of cancer of the external auditory canal and middle ear.