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External auditory canal and middle ear involvement is an uncommon initial presentation for early primary nasopharyngeal carcinoma. Previously reported cases were only associated with advanced skull base erosion or recurrence after radical treatment. We present a patient with nasopharyngeal carcinoma with a small inconspicuous primary tumour in the nasopharynx without skull base erosion, but who first presented with auditory symptoms and was found to have biopsy-proven external auditory canal involvement. Contrastenhanced magnetic resonance imaging and 18 F-fluorodeoxyglucose-positron emission tomography clearly demonstrated the route of extension via the Eustachian tube into the middle ear and mastoid air cells. This report highlights the importance of heightened vigilance for nasopharyngeal carcinoma and careful nasal endoscopic examination when encountering an undifferentiated carcinoma of the external auditory canal, especially in areas endemic for nasopharyngeal carcinoma. Similarly, otoscopic examination and modern imaging techniques such as magnetic resonance imaging or positron emission tomography are invaluable for investigating suspected nasopharyngeal carcinoma that presents as auditory symptoms.

18018 Background: Erlotinib significantly improved survival versus placebo and was well tolerated in patients (pts) with previously treated advanced NSCLC in the phase III BR.21 study (Shepherd et al. N Engl J Med 2005;353;123–32). TRUST, an open-label, multicenter study was initiated to provide erlotinib access to pts with advanced NSCLC. Here we report data for E/SE Asian pts. Methods: Eligible pts had failed 1–2 prior standard chemotherapy (CT) regimens, or were unsuitable for CT. Erlotinib 150 mg/day p.o. was given until disease progression/unacceptable toxicity. NCI CTC v3.0 was used to grade toxicities. Results: At data cut-off of 20/11/06, 885 pts were included in the analysis: n= Taiwan 297, mainland China 248, Hong Kong 160, South Korea 146, Thailand 30, Indonesia 2, Malaysia 2. Median age was 61yrs (range 22–95). Pt characteristics (%): male/female 55/45, ECOG PS 0/1/2/3 15/67/14/4, stage IIIb/IV 20/79, adenocarcinoma/other 68/32, erlotinib as 1st/2nd/3rd/other line therapy 11/55/33/<1, never/ever smoker 52/47 (no data <1). 83% pts experienced rash, of which 9% was grade (gr)3/4. Safety data forms were available for 598 pts; 54% had at least one adverse event (AE).104 pts (17%) had a treatment (tx)-related unexpected adverse event (AE) but no single AE occurred in >3% pts and only 3% were ≥gr3. Serious tx-related AEs were experienced by 19 pts (3%); 17 were gr3/4, most commonly gastrointestinal (n=6). One pt had suspected tx-related interstitial lung disease (gr2); the patient continued tx. 18 pts (3%) withdrew due to a tx-related event; 11 were gr3/4, most commonly gastrointestinal (n=4) and respiratory (idiopathic pulmonary fibrosis n=1, pneumonitis n=2). 76 pts (13%) required dose reduction due to a tx-related event (13%), mainly due to rash (n=57). 83% pts received erlotinib for >4 weeks. Efficacy will be presented. Conclusions: The results reported here for E/SE Asian pts in the TRUST study confirm in a community setting the good tolerability observed with erlotinib in clinical trials. Importantly, erlotinib was generally well tolerated and so could be administered at full tx dose to most pts. [Table: see text]

Objective:To review the outcomes of postoperative radiotherapy (PORT) using three-dimensional conformal techniques in patients with resected pathological N2 (pN2) non-small-cell lung cancer (NSCLC). Methods: Consecutive patients who underwent PORT for resected pN2 NSCLC were retrospectively reviewed. Adjuvant chemotherapy was given before PORT. Locoregional and systemic recurrences, disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Factors associated with DFS and OS were determined using the log-rank test. Results: Eight men and seven women aged 38 to 76 (median, 65) years were included. All had stage IIIA cancer and underwent lobectomy. 12 and three patients had single and multiple mediastinal lymph node station involvement, respectively. The median numbers of resected lymph nodes and lymph node stations were 6 and 4, respectively. Only five patients underwent systematic nodal dissection or sampling. 13 patients underwent adjuvant chemotherapy. The median follow-up period was 31.9 months. Actuarial locoregional control was 100% at 1 year, 92.4% at 2 years, and 82.0% at 3 years. Ten patients had recurrence; all had distant metastases as the first failure event. The median time to recurrence was 12.6 months. DFS was 66.5% at 1 year, 46.5% at 2 years, and 40.0% at 3 years; the median DFS was 14.9 months. OS was 93.5% at 1 year, 66.5% at 2 years, and 51.5% at 3 years; the median OS was 42.4 months. There were nine deaths; eight were cancer-related and one was of unknown cause. Multiple pN2 lymph node station involvement was the only variable that was significant for both DFS and OS. Compared with patients with single pN2 lymph node station involvement, patients with multiple pN2 lymph node station involvement had shorter median DFS (10.9 months vs. 29.2 months, p = 0.008) and median OS (12.1 months vs. 54.1 months, p = 0.003). No patient had grade 3 or above toxicities. Conclusion: PORT using modern techniques and dose fractionation for patients with resected pN2 NSCLC was well tolerated and resulted in a high locoregional control rate, but the rate of distant metastasis remained high. Patients with multiple pN2 lymph node station involvement had worse survival.