Carcinoma of the External Auditory Canal and Middle Ear: Staging and Management Dilemma

Abstract

Objectives: This study aims to figure out more accurate staging and proper therapeutic strategy for carcinoma of external auditory canal and middle ear. Study Design: Retrospective review of medical records of patients who were diagnosed as squamous cell carcinoma or adenoid cystic carcinoma of external auditory canal and middle ear between 1989 and 2006. Materials and Methods: 34 patients were enrolled in this study. First, treatment outcomes according to pathologies and stages were investigated. Second, surgical outcomes according to different tumor extent and surgical methods in the same stage were investigated . Third, survival rate according to local invasion to adjacent structures such as parotid gland, facial nerve, temporomandibular joint, infratemporal fossa, dura and intracranium, all of which had been frequently used in other staging systems was investigated. Fourth, the effect of adjuvant radiotherapy in advanced stage (stage III, N) was investigated by comparing the survival rate between the patients who underwent radiotherapy with the patients who did not undergo radiotherapy. Results: Patients of stage I and II showed 90% disease control rates with lateral temporal bone resection (LTBR). However, the survival rates were significantly decreased in stage III and IV. In stage III, LTBR was performed in patients whose tumor was confined to the external auditory canal and middle ear and subtotal temporal bone resection was performed in patients with tumor extending into the mastoid. The difference in disease control rates of the two groups were not significant (p > 0.05). The disease control rates were significantly decreased in the patients with ACC where parotid gland invasion was present (p = 0.007) and in the patients with SCC where dural and intracranial invasion was present (p = 0.001). There was no significant survival difference between the patients who underwent adjuvant radiotherapy and the patients who did not (p > 0.05). Conclusions: For the staging system of carcinoma of external auditory canal and middle ear, it can be concluded that staging system needs to be modified. Stage I and II can be put together since the tumors of those stages showed excellent disease control rates . And stage III tumors confined to the external auditory canal and middle ear can be subdivided into two groups, some of which could be included in earlier stage. For the treatment, LTBR seems to be sufficient for stage I, II and limited cases of stage III where tumor is confined to the external auditory canal and middle ear only. In more advanced stages, adjuvant radiotherapy hardly showed any benefit, and therefore initial surgical treatment is more important.