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Objective There are no well-defined treatment recommendations for elderly patients with advanced head and neck squamous cell carcinoma. This study aimed to investigate whether aggressive treatment among the elderly translated into better survival outcomes. Study Design Retrospective cohort study. Setting Single tertiary institution. Subjects and Methods Elderly patients (≥60 years) with advanced-stage head and neck squamous cell carcinoma (stage III and IV) treated between January 1991 and May 2014 were reviewed. According to current National Comprehensive Cancer Network guidelines, they were classified to have received standard or substandard treatment. Overall survival (OS), locoregional recurrence-free survival, and distant recurrence-free survival were evaluated. Results A total of 355 patients were treated curatively: 194 with up-front surgery and 161 with radiotherapy or concurrent chemotherapy and radiotherapy. Median OS was higher among patients who received standard treatment (42.0 vs 16.0 months, P < .001). On multivariate analysis, standard treatment showed superior OS (P < .001). Use of substandard treatment showed a hazard ratio of 2.09 (95% CI, 1.59-2.74) for poorer OS. Conclusion Aggressive standard treatment protocols should be advocated for elderly patients, where comorbidities permit, as they confer better outcomes.

ObjectiveThis study aimed to investigate the prognostic factors and treatment outcomes in patients with the external auditory canal (EAC) squamous cell carcinoma (SCC).MethodsAll patients diagnosed with EAC SCC and treated with curative intent at a single tertiary institution were retrospectively reviewed over a 22‐year period. Treatment modalities included surgery with adjuvant treatment or definitive radiotherapy. The primary endpoints were overall survival (OS) and disease‐specific survival (DSS).ResultsThere were 51 patients in our cohort. The 5‐year OS and DSS were 64.0% ± 7.0% and 72.0% ± 7.0% respectively. Patients in the surgical arm and RT arm showed no significant difference in OS, DSS, and LRFS (p = 0.075, 0.062, 0.058 respectively). Compared to other routes of spread within the temporal bone, pattern of posterior disease invasion (involving mastoid/sigmoid sinus) showed poorer OS and DSS on multivariate analysis (hazard ratio, HR4.34 and 5.88; p = 0.006 and 0.009). On multivariate analysis, the following factors were independently prognostic of poorer OS and DSS: Previous radiotherapy (HR 3.29 and 4.81, p = 0.021 and p = 0.029); Presence of facial nerve palsy (HR 3.80 and 7.63, p = 0.013 and p = 0.003); Posterior pattern of invasion (HR4.05 and 3.59, p = 0.013 and p = 0.043). Advanced modified Pittsburgh stage was not predictive of poor OS and DSS (HR1.17 and 1.17 E+5, p = 0.786 and p = 0.961).ConclusionPresence of previous radiotherapy, facial nerve palsy and posterior pattern of disease invasion were independent prognostic factors of poorer survival in patients with EAC SCC.Level of Evidence4 Laryngoscope, 133:2203–2210, 2023

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Purpose/Objective(s): External auditory canal (EAC) carcinoma is rare, and despite multiple different staging systems proposed, prognosis is poor. Presently, there are no standard guidelines on treatment modalities as well. Hence this study aims to investigate the prognostic factors and treatment outcomes in patients with EAC carcinoma. Materials/Methods: All patients diagnosed with primary EAC and treated with curative intent at a single tertiary institution were retrospectively reviewed over a 22-year period. Patients were staged with the modified Pittsburgh staging system. Thirty-seven patients (77.5%) were treated with surgery alone or combined with postoperative radiotherapy (RT) and/or concurrent chemotherapy (CRT). Nine patients (22.5%) received definitive RT or CRT. Baseline and clinical characteristics were collected, and survival outcomes analyzed using the KaplaneMeier method. Comparisons were made using log-rank test. Median follow up was 8.3 years. Results: There were 40 patients with EAC carcinoma in our cohort. The 5year overall survival (OS), 5-year disease specific survival (DSS) and 5year locoregional free survival (LRFS) were 66% AE 9%, 70% AE 9%, and 60% AE 11% respectively. Majority (92%) of relapses were locoregional. On univariate analysis, the factors predictive of OS were age and surgical treatment (PZ.027 and PZ.049, respectively). Although facial nerve palsy did not show a significant difference in OS (PZ.091), it showed a significant difference in DSS and LRFS (PZ.005 and PZ.000, respectively). Group stage, T-stage, N-stage, histology grade, histology margins, ECOG performance status, and ACE-27 comorbidity scores did not show a significant difference in OS, DSS, and LRFS. Conclusion: Younger age, absence of facial nerve palsy, and surgical treatment showed significantly better survival outcomes in patients with EAC carcinoma.