Clinical management for T1 and T2 external auditory canal cancer

• Published in: Auris, nasus, larynx nasus, larynx, 2019-10, Vol.46 (5), p.785-789
• Main Authors: Shinomiya, Hirotaka, Uehara, Natsumi, Teshima, Masanori, Kakigi, Akinori, Otsuki, Naoki, Nibu, Ken-ichi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Disease-Free Survival; Ear Canal - diagnostic imaging; Ear Canal - surgery; Ear Neoplasms - diagnostic imaging; Ear Neoplasms - pathology; Ear Neoplasms - therapy; External auditory canal cancer; Female; Humans; Lateral temporal bone resection; Lymph Nodes - pathology; Lymph Nodes - surgery; Magnetic Resonance Imaging; Male; Margins of Excision; Middle Aged; Neck Dissection - methods; Neoplasm Invasiveness; Neoplasm Staging; Otorhinolaryngologic Surgical Procedures - methods; Parotid Gland - surgery; Parotidectomy; Positron-Emission Tomography; Postoperative radiotherapy; Proton Therapy; Radiotherapy, Adjuvant; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck - diagnostic imaging; Squamous Cell Carcinoma of Head and Neck - pathology; Squamous Cell Carcinoma of Head and Neck - therapy; Temporal Bone - surgery; Temporal bone cancer; Tomography, X-Ray Computed
• ISSN: 0385-8146; 1879-1476
• DOI: 10.1016/j.anl.2019.02.004

The purpose of this study was to clarify the impact of superficial parotidectomy and postoperative radiotherapy (PORT) for the surgical treatment of early stage squamous cell carcinoma (SCC) in external auditory canal (EAC). Thirty-seven patients with T1 (n = 14) or T2 (n = 19) SCC in EAC treated between 2000 and 2016 at Kobe University Hospital were enrolled in this study. Thirty-three patients were operated with sleeve resection or lateral temporal bone resection. The 5-year overall survival and disease-specific survival rates were 95% and 100%, respectively. Surgical margin was positive in 4 patients, who were treated by PORT and have been alive without disease. Prophylactic superficial parotidectomy was simultaneously performed at the time of initial surgery in 15 patients, in whom no lymph node (LN) metastasis was observed. Among the other 22 patients, regional recurrence in parotid LN was observed in one patient, who was successfully salvaged by total parotidectomy. Potential parotid lymph node metastasis rates of T1 and T2 SCC in EAC was 0% (0/14) and 5% (1/19) respectively. Complete resection without positive surgical margins is essential for the treatment of the patients with T1 and T2 ear cancers. Prophylactic superficial parotidectomy or neck dissection is not mandatory for T1 and T2 diseases, as long as precisely extent of disease is assessed preoperatively. PORT should be performed for the patients with positive surgical margins. Levels of evidence: 4.