Treatment Strategies for Malignancies of the External Auditory Canal

Zhong, Shixun; Zuo, Wenqi

doi:10.1007/s11864-021-00931-3

Cited by 9 publications

(17 citation statements)

References 68 publications

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“…Unfortunately, TBSCC of the EAC are often diagnosed late; in the literature, average time from symptom presentation to diagnosis ranges from 12.4 months to 3.9 years [ 47 ]. Consequently, the rate of advanced tumors at diagnosis is high; in our pooled analysis, we found 57.1% of cT3-4 tumors at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes in Squamous Cell Carcinoma of the External Auditory Canal: A Systematic Review and Meta-Analysis

Cazzador

Franz

Tealdo

et al. 2023

JCM

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Squamous cell carcinomas (SCC) of the external auditory canal (EAC) are rare tumors representing a surgical challenge. Current knowledge is based largely on case series; thus, the level of evidence is weak. This study sought to systematically review the available SCC of the EAC literature and to identify risk factors for overall survival (OS) and disease-specific survival (DSS). A systematic review and meta-analysis of papers searched up to December 2022 through PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted. Quality assessment of the eligible studies was done according to the Newcastle-Ottawa Scale. Pooled univariate and multivariable analyses and meta-analysis using a random-effects or fixed-effects Mantel-Haenszel model were performed. Fifteen articles (282 patients) met the inclusion criteria and were included in the quantitative analysis. The pooled multivariable analysis revealed cT3 and cT4 as independent prognostic factors for OS (p = 0.005, and p < 0.001, respectively) and DSS (p = 0.002, and p < 0.001, respectively). Local recurrence rate was 32.3%. The meta-analysis estimated significantly higher odds ratios for advanced T categories, than cT1-T2 tumors for OS and DSS (OR = 3.55; 95% CI, 1.93–6.52, and OR = 3.73; 95% CI, 2.00–6.97, respectively). In conclusion, locally advanced tumors were associated with poor prognosis. Poor outcomes mostly occurred due to local recurrence.

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Section: Discussionmentioning

confidence: 99%

Survival Outcomes in Squamous Cell Carcinoma of the External Auditory Canal: A Systematic Review and Meta-Analysis

Cazzador

Franz

Tealdo

et al. 2023

JCM

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“…The parotid is also susceptible to extension of tumor in the EAC. It has been reported that the incidence of parotid involvement in SCC of the EAC is between 10 and 62% of patients [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Technical details and clinical outcomes after high-dose-rate intracavitary brachytherapy for squamous cell carcinoma of external auditory canal and external beam radiotherapy for nodal coverage: A case report

Dumago¹,

Yu²,

Jacomina³

et al. 2023

jcb

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Purpose To report technical details and 15-month outcomes of a patient with node-positive external auditory canal (EAC) squamous cell carcinoma (SCC) treated with definitive intracavitary high-dose-rate (HDR) brachytherapy to primary tumor, and external beam radiotherapy (EBRT) to draining lymphatics. Material and methods A 21-year-old male was diagnosed with SCC of the right EAC. The patient underwent definitive HDR intracavitary brachytherapy, 340 cGy/fraction for 14 twice-daily fractions, followed by EBRT using intensity-modulated radiation therapy (IMRT) to cover the grossly enlarged pre-auricular node, ipsilateral intra-parotid, and cervical lymph node levels II and III. Results The approved brachytherapy plan had an average high-risk clinical tumor volume (CTV-HR) D 90 of 341 cGy with a total dose of 47.7 Gy (BED, 80.3 Gy, EQD 2 , 66.6 Gy). For the approved IMRT plan, the prescription to the involved right pre-auricular node was 66 Gy in 33 fractions, and more than 95% of the target received at least 62.7 Gy. High-risk nodal regions were simultaneously prescribed: 59.4 Gy in 1.8 Gy fractions, and more than 95% received at least 56.4 Gy. Organs at risk (OARs) were kept below their dose constraints. The patient tolerated both the procedures with no grade ≥ 2 treatment-related adverse events. Grade 1 dermatitis in the right pre-auricular and cervical areas during the course of EBRT was experienced. Fifteen months post-RT, the patient has no evidence of disease, and was noted to have EAC stenosis, which translated to moderate conductive hearing loss of the right ear. Thyroid function was normal at 15 months after EBRT. Conclusions This case report illustrates that the delivered definitive radiotherapy is technically feasible, effective, and well-tolerated in patients with SCC of EAC.

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“…So, to improve their prognosis, external-beam radiotherapy (EBRT) in conjunction with chemotherapy can be applied. Impressive results by Nagano et al [15] from 21 patients with stage III-IV EAC cancer and Katano et al [16] from 34 patients with stage I-IV EAC cancer suggest that the combination therapy of EBRT and surgery and/or chemotherapy may be the most effective treatment options for advanced EAC cancer. Actually, EBRT with simultaneous chemotherapy is the most acceptable pattern.…”

Section: Determining the Place Of Radiation In The Treatment Of Eac C...mentioning

confidence: 99%

“…The docetaxel + cisplatin + 5FU (DCF) regimen seems the most effective method with high overall survival and reduced loco-regional recurrences. Some studies support the infusion of intra-arterial cisplatin in combination with radiotherapy for locally advanced cases [ 17 ]. Moreover, induction chemotherapy has been shown to convert potentially unresectable tumors to a resectable disease that could produce better outcomes.…”

Section: Improvement Of the Prognosis Of Eac Carcinomasmentioning

confidence: 99%

Malignant tumors of the external auditory canal: diagnosis, treatment, genetic landscape, biomarkers, and clinical outcome

Athanasopoulos,

Goulioumis,

Athanasopoulos

2023

Exploration of Targeted Anti-Tumor Therapy

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Malignant tumors of the external auditory canal (EAC) are rare neoplasms that appear in the head and neck area. A common feature of these malignancies is their rarity, as well as their delayed diagnosis due to the appearance of non-specific symptoms that mimic various benign otologic conditions. The reported histological types of cancer of the external ear are: squamous cell carcinoma, basal cell carcinoma, malignant melanoma, Merkel cell carcinoma, angiosarcoma, adnexal carcinoma (including ceruminous adenocarcinoma and adenoid cystic carcinoma), and lymphoma (Lancet Oncol. 2005;6:411–20. doi: 10.1016/S1470-2045(05)70208-4). Several therapeutic interventions have been proposed, primarily orientated towards the cure of the patient, placing the surgical excision of the lesions at the tip of the spear. Subsequently and depending on the clinical stage and the pathological characteristics of the tumor, radiation, chemotherapy, a combination thereof, or some form of palliative treatment for particularly advanced cases, may be recommended. The aim of all the above-mentioned approaches is the complete resection of the mass with negative surgical margins along with lymph node dissection, the elimination of any residual disease or metastasis, and the improvement of survival. The anatomical complexity of the region will always remain a demanding challenge. Nevertheless, advances in the fields of ear microsurgery, imaging, radiation, molecular biology, and genomics have led to remarkable outcomes compared to the past, with a view to the patient’s quality of life. Large, well-organized, and prospective studies with the participation of multiple centers in contrast to existing retrospective studies with a limited number of patients will help to establish universally accepted guidelines. The exploration of the molecular and genetic background of these cancers in conjunction with the search for new biomarkers and target molecules seems promising for providing upgraded and more personalized treatment modalities for the future.

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Treatment Strategies for Malignancies of the External Auditory Canal

Cited by 9 publications

References 68 publications

Survival Outcomes in Squamous Cell Carcinoma of the External Auditory Canal: A Systematic Review and Meta-Analysis

Survival Outcomes in Squamous Cell Carcinoma of the External Auditory Canal: A Systematic Review and Meta-Analysis

Technical details and clinical outcomes after high-dose-rate intracavitary brachytherapy for squamous cell carcinoma of external auditory canal and external beam radiotherapy for nodal coverage: A case report

Malignant tumors of the external auditory canal: diagnosis, treatment, genetic landscape, biomarkers, and clinical outcome

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