Treatment And Outcome Of Advanced External Auditory Canal And Middle Ear Malignant Tumors

Presentation: S122
Topic: Skin Cancers
Type: Oral
Date: Sunday, July 17, 2016
Session: 3:45 PM - 5:15 PM Skin
Authors: Giovanni Cristalli, MD, Giuseppe Mercante, MD, Valentina Manciocco, PhD, Giuseppe Spriano, MD
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Institution(s): Regina Elena National Cancer Institute
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Background: The recommended therapeutic strategy in advanced ear cancer consists of surgical excision and postoperative radiotherapy. The purpose of this study was to evaluate the complications and oncologic outcomes of patients treated by surgery, intraoperative radiotherapy (IORT)  and combined image modulated radiotherapy (IMRT)  in   locally advanced ear cancer.

Methods: 38 consecutive patients with locally advanced ear cancer treated between January 2002 and February 2014 were retrospectively evaluated.  25 (65%) patients had a primary tumor, while 13 (35%) patients had a recurrence. 7 (19%) patients were stage II , 17 (46%) patients were stage III and 14 (36%) patients were stage IV, according to the University of Pittsburgh staging system. No preoperative facial paralysis was present. 33 (89%)  patients underwent lateral temporal bone resection, 4 (11%) patients were treated by “sleeve resection”. Neck dissection and parotidectomy were also performed in 32 (85%) of 37 cases. Pedicle flap was used for reconstruction in 29 (77%) cases. No patients had gross tumour residual. 13 (34%) patients received IORT followed by IMRT, 13 (33%) cases had IMRT alone, while 12 (32.5%) cases did not received any adjuvant treatment.

Results: Median follow-up was 40 months. The 5-year disease free survival was 79.1% for stage II-III and 49.3% for stage IV. The 5-year overall survival was 80.4% for stage II-III and for stage IV 49.4%. The facial nerve was sacrificed in 13 cases. Sural nerve grafting was performed in 7 of 12 cases after facial nerve resection, recovery to stage IV according to the House-Brackmann classification was achieved in 3 cases, to stage V in 2 cases and no recovery 1 case. Peripheral flap necrosis was observed in 4 cases and condritis of the remnant external ear in 2 cases.

Conclusion: Advanced external auditory canal and middle ear malignancies are rare. Treatment options include surgery and radiotherapy. Radical resection of the primary followed by radiotherapy may allow good prognosis in early stages. IORT seems to maximize the results of radiation therapy reducing side effects. Further studies are required to confirm the advantages of IORT in terms of survival.

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