Treatment of squamous cell carcinoma of external auditory canal: A tertiary cancer centre experience
Abstract Objective Carcinoma of external auditory canal (EAC) is a rare disease with variable management strategies and prognosis. We aimed to analyze treatment modalities, prognostic factors and survival outcomes in patients of squamous cell carcinoma of EAC treated at our institution. Methods Fort...
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| Veröffentlicht in: | Auris, nasus, larynx nasus, larynx, 2016-02, Vol.43 (1), p.45-49 |
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| creator | Gandhi, Ajeet Kumar Roy, Soumyajit Biswas, Ahitagni Raza, Mohd Waseem Saxena, Tripti Bhasker, Suman Sharma, Atul Thakar, Alok Mohanti, Bidhu Kalyan |
| description | Abstract Objective Carcinoma of external auditory canal (EAC) is a rare disease with variable management strategies and prognosis. We aimed to analyze treatment modalities, prognostic factors and survival outcomes in patients of squamous cell carcinoma of EAC treated at our institution. Methods Forty-three patients of squamous cell carcinoma of EAC were analyzed for clinical presentation, stage, surgical procedures and radiotherapy (RT) modalities employed. Stell and McCormick staging system was used for staging of the patients. Progression free survival (PFS) was estimated by the use of Kaplan–Meier product-limit method. Log rank test was used to assess the impact of prognostic variables on PFS. Multivariate analysis was performed using the Cox hazard regression model. p value of 50%) and 7 patients had PR to palliative RT. After a median follow-up of 16 months, median PFS for the entire cohort was 14 months. Two-year PFS rates were 85.7%, 46.9% and 0% for patients treated with surgery and post-operative RT, definitive RT and palliative RT respectively. On univariate analysis, higher stage ( p = 0.05) and facial nerve palsy at presentation ( p = 0.0008) were significant predictors of inferior PFS. Conclusion Patients with carcinoma of EAC present mostly in advanced stage at our centre. Combined higher stage (T3) and facial nerve palsy at presentation portend poorer outcome. Combined modality treatment with surgery and radiotherapy should be advocated and palliative RT remains a reasonable treatment option in patients with advanced incurable disease. |
| doi_str_mv | 10.1016/j.anl.2015.06.005 |
| format | Article |
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We aimed to analyze treatment modalities, prognostic factors and survival outcomes in patients of squamous cell carcinoma of EAC treated at our institution. Methods Forty-three patients of squamous cell carcinoma of EAC were analyzed for clinical presentation, stage, surgical procedures and radiotherapy (RT) modalities employed. Stell and McCormick staging system was used for staging of the patients. Progression free survival (PFS) was estimated by the use of Kaplan–Meier product-limit method. Log rank test was used to assess the impact of prognostic variables on PFS. Multivariate analysis was performed using the Cox hazard regression model. p value of <0.05 was considered significant for all statistical analysis. Results Median age was 56 years (range: 12–84 years). Male to female ratio was 31:12. Stage was T1, T2 and T3 in 2, 17 and 18 patients respectively. Sixteen patients underwent surgery. Thirty-six patients received RT (14 received definitive RT, 11 had post-operative RT and 11 had RT with palliative intent). Eight patients (16%) received chemotherapy (5 received concurrent with RT, 2 had adjuvant and 1 had neo-adjuvant chemotherapy). Nine patients (of 11 patients) achieved a complete response (CR) and 2 achieved a partial response (PR) after surgery plus post-operative RT. Nine patients and 5 patients respectively achieved CR and PR after definitive RT (with or without concurrent chemotherapy). Of the 11 patients who received palliative RT, 2 had very good objective response (>50%) and 7 patients had PR to palliative RT. After a median follow-up of 16 months, median PFS for the entire cohort was 14 months. Two-year PFS rates were 85.7%, 46.9% and 0% for patients treated with surgery and post-operative RT, definitive RT and palliative RT respectively. On univariate analysis, higher stage ( p = 0.05) and facial nerve palsy at presentation ( p = 0.0008) were significant predictors of inferior PFS. Conclusion Patients with carcinoma of EAC present mostly in advanced stage at our centre. Combined higher stage (T3) and facial nerve palsy at presentation portend poorer outcome. Combined modality treatment with surgery and radiotherapy should be advocated and palliative RT remains a reasonable treatment option in patients with advanced incurable disease.</description><identifier>ISSN: 0385-8146</identifier><identifier>EISSN: 1879-1476</identifier><identifier>DOI: 10.1016/j.anl.2015.06.005</identifier><identifier>PMID: 26165629</identifier><language>eng</language><publisher>Netherlands: Elsevier Ireland Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents - therapeutic use ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Cancer Care Facilities ; Carboplatin - administration & dosage ; Carcinoma ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - therapy ; Chemoradiotherapy, Adjuvant ; Child ; Cisplatin - therapeutic use ; Disease-Free Survival ; Ear Canal - surgery ; Ear Neoplasms - pathology ; Ear Neoplasms - therapy ; External auditory canal ; Female ; Head and Neck Neoplasms - pathology ; Head and Neck Neoplasms - therapy ; Humans ; Kaplan-Meier Estimate ; Lymph Nodes - pathology ; Male ; Middle Aged ; Neck Dissection ; Neoadjuvant Therapy ; Neoplasm Staging ; Otolaryngology ; Otologic Surgical Procedures ; Paclitaxel - administration & dosage ; Prognosis ; Proportional Hazards Models ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies ; Squamous Cell Carcinoma of Head and Neck ; Tertiary Care Centers ; Treatment Outcome ; Young Adult</subject><ispartof>Auris, nasus, larynx, 2016-02, Vol.43 (1), p.45-49</ispartof><rights>Elsevier Ireland Ltd</rights><rights>2015 Elsevier Ireland Ltd</rights><rights>Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-fae8414827a55fa44cce1e1a694f665148f7dd48f1e50cac9e4ff399efcb9b543</citedby><cites>FETCH-LOGICAL-c502t-fae8414827a55fa44cce1e1a694f665148f7dd48f1e50cac9e4ff399efcb9b543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0385814615001637$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26165629$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gandhi, Ajeet Kumar</creatorcontrib><creatorcontrib>Roy, Soumyajit</creatorcontrib><creatorcontrib>Biswas, Ahitagni</creatorcontrib><creatorcontrib>Raza, Mohd Waseem</creatorcontrib><creatorcontrib>Saxena, Tripti</creatorcontrib><creatorcontrib>Bhasker, Suman</creatorcontrib><creatorcontrib>Sharma, Atul</creatorcontrib><creatorcontrib>Thakar, Alok</creatorcontrib><creatorcontrib>Mohanti, Bidhu Kalyan</creatorcontrib><title>Treatment of squamous cell carcinoma of external auditory canal: A tertiary cancer centre experience</title><title>Auris, nasus, larynx</title><addtitle>Auris Nasus Larynx</addtitle><description>Abstract Objective Carcinoma of external auditory canal (EAC) is a rare disease with variable management strategies and prognosis. We aimed to analyze treatment modalities, prognostic factors and survival outcomes in patients of squamous cell carcinoma of EAC treated at our institution. Methods Forty-three patients of squamous cell carcinoma of EAC were analyzed for clinical presentation, stage, surgical procedures and radiotherapy (RT) modalities employed. Stell and McCormick staging system was used for staging of the patients. Progression free survival (PFS) was estimated by the use of Kaplan–Meier product-limit method. Log rank test was used to assess the impact of prognostic variables on PFS. Multivariate analysis was performed using the Cox hazard regression model. p value of <0.05 was considered significant for all statistical analysis. Results Median age was 56 years (range: 12–84 years). Male to female ratio was 31:12. Stage was T1, T2 and T3 in 2, 17 and 18 patients respectively. Sixteen patients underwent surgery. Thirty-six patients received RT (14 received definitive RT, 11 had post-operative RT and 11 had RT with palliative intent). Eight patients (16%) received chemotherapy (5 received concurrent with RT, 2 had adjuvant and 1 had neo-adjuvant chemotherapy). Nine patients (of 11 patients) achieved a complete response (CR) and 2 achieved a partial response (PR) after surgery plus post-operative RT. Nine patients and 5 patients respectively achieved CR and PR after definitive RT (with or without concurrent chemotherapy). Of the 11 patients who received palliative RT, 2 had very good objective response (>50%) and 7 patients had PR to palliative RT. After a median follow-up of 16 months, median PFS for the entire cohort was 14 months. Two-year PFS rates were 85.7%, 46.9% and 0% for patients treated with surgery and post-operative RT, definitive RT and palliative RT respectively. On univariate analysis, higher stage ( p = 0.05) and facial nerve palsy at presentation ( p = 0.0008) were significant predictors of inferior PFS. Conclusion Patients with carcinoma of EAC present mostly in advanced stage at our centre. Combined higher stage (T3) and facial nerve palsy at presentation portend poorer outcome. Combined modality treatment with surgery and radiotherapy should be advocated and palliative RT remains a reasonable treatment option in patients with advanced incurable disease.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Cancer Care Facilities</subject><subject>Carboplatin - administration & dosage</subject><subject>Carcinoma</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Chemoradiotherapy, Adjuvant</subject><subject>Child</subject><subject>Cisplatin - therapeutic use</subject><subject>Disease-Free Survival</subject><subject>Ear Canal - surgery</subject><subject>Ear Neoplasms - pathology</subject><subject>Ear Neoplasms - therapy</subject><subject>External auditory canal</subject><subject>Female</subject><subject>Head and Neck Neoplasms - pathology</subject><subject>Head and Neck Neoplasms - therapy</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymph Nodes - pathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neck Dissection</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Otolaryngology</subject><subject>Otologic Surgical Procedures</subject><subject>Paclitaxel - administration & dosage</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Radiotherapy</subject><subject>Radiotherapy, Adjuvant</subject><subject>Retrospective Studies</subject><subject>Squamous Cell Carcinoma of Head and Neck</subject><subject>Tertiary Care Centers</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0385-8146</issn><issn>1879-1476</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU1r3DAQFaWl2aT9Ab0EH3uxo7El2WohEEKbFAI9ND0LrTwCbfyxkeSQ_PuOu2kPOeSiQfM-4L1h7BPwCjios11lp6GqOciKq4pz-YZtoGt1CaJVb9mGN50sOxDqiB2ntOOcN22j37OjWoGSqtYb1t9GtHnEKRezL9L9Ysd5SYXDYSicjS5M82hXCB8zxskOhV36kOf4RDB9vxQXBQE52MPGYSTxlCOSYo8xIK0-sHfeDgk_Ps8T9vv7t9vL6_Lm59WPy4ub0kle59Jb7ASIrm6tlN4K4RwCglVaeKUkIb7te3oBJXfWaRTeN1qjd1u9laI5YZ8Pvvs43y-YshlDWqPYCSmVgZYyqxaEJiocqC7OKUX0Zh_DSCEMcLOWa3aGyjVruYYrQ-WS5vTZftmO2P9X_GuTCF8PBKSQDwGjSe5vAX2I6LLp5_Cq_fkLtRvCFJwd7vAJ025e1v4phUm14ebXet31uCA5GdJl_wCe0qC-</recordid><startdate>20160201</startdate><enddate>20160201</enddate><creator>Gandhi, Ajeet Kumar</creator><creator>Roy, Soumyajit</creator><creator>Biswas, Ahitagni</creator><creator>Raza, Mohd Waseem</creator><creator>Saxena, Tripti</creator><creator>Bhasker, Suman</creator><creator>Sharma, Atul</creator><creator>Thakar, Alok</creator><creator>Mohanti, Bidhu Kalyan</creator><general>Elsevier Ireland Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160201</creationdate><title>Treatment of squamous cell carcinoma of external auditory canal: A tertiary cancer centre experience</title><author>Gandhi, Ajeet Kumar ; Roy, Soumyajit ; Biswas, Ahitagni ; Raza, Mohd Waseem ; Saxena, Tripti ; Bhasker, Suman ; Sharma, Atul ; Thakar, Alok ; Mohanti, Bidhu Kalyan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-fae8414827a55fa44cce1e1a694f665148f7dd48f1e50cac9e4ff399efcb9b543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Cancer Care Facilities</topic><topic>Carboplatin - administration & dosage</topic><topic>Carcinoma</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Chemoradiotherapy, Adjuvant</topic><topic>Child</topic><topic>Cisplatin - therapeutic use</topic><topic>Disease-Free Survival</topic><topic>Ear Canal - surgery</topic><topic>Ear Neoplasms - pathology</topic><topic>Ear Neoplasms - therapy</topic><topic>External auditory canal</topic><topic>Female</topic><topic>Head and Neck Neoplasms - pathology</topic><topic>Head and Neck Neoplasms - therapy</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymph Nodes - pathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neck Dissection</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Otolaryngology</topic><topic>Otologic Surgical Procedures</topic><topic>Paclitaxel - administration & dosage</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Radiotherapy</topic><topic>Radiotherapy, Adjuvant</topic><topic>Retrospective Studies</topic><topic>Squamous Cell Carcinoma of Head and Neck</topic><topic>Tertiary Care Centers</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gandhi, Ajeet Kumar</creatorcontrib><creatorcontrib>Roy, Soumyajit</creatorcontrib><creatorcontrib>Biswas, Ahitagni</creatorcontrib><creatorcontrib>Raza, Mohd Waseem</creatorcontrib><creatorcontrib>Saxena, Tripti</creatorcontrib><creatorcontrib>Bhasker, Suman</creatorcontrib><creatorcontrib>Sharma, Atul</creatorcontrib><creatorcontrib>Thakar, Alok</creatorcontrib><creatorcontrib>Mohanti, Bidhu Kalyan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Auris, nasus, larynx</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gandhi, Ajeet Kumar</au><au>Roy, Soumyajit</au><au>Biswas, Ahitagni</au><au>Raza, Mohd Waseem</au><au>Saxena, Tripti</au><au>Bhasker, Suman</au><au>Sharma, Atul</au><au>Thakar, Alok</au><au>Mohanti, Bidhu Kalyan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of squamous cell carcinoma of external auditory canal: A tertiary cancer centre experience</atitle><jtitle>Auris, nasus, larynx</jtitle><addtitle>Auris Nasus Larynx</addtitle><date>2016-02-01</date><risdate>2016</risdate><volume>43</volume><issue>1</issue><spage>45</spage><epage>49</epage><pages>45-49</pages><issn>0385-8146</issn><eissn>1879-1476</eissn><abstract>Abstract Objective Carcinoma of external auditory canal (EAC) is a rare disease with variable management strategies and prognosis. We aimed to analyze treatment modalities, prognostic factors and survival outcomes in patients of squamous cell carcinoma of EAC treated at our institution. Methods Forty-three patients of squamous cell carcinoma of EAC were analyzed for clinical presentation, stage, surgical procedures and radiotherapy (RT) modalities employed. Stell and McCormick staging system was used for staging of the patients. Progression free survival (PFS) was estimated by the use of Kaplan–Meier product-limit method. Log rank test was used to assess the impact of prognostic variables on PFS. Multivariate analysis was performed using the Cox hazard regression model. p value of <0.05 was considered significant for all statistical analysis. Results Median age was 56 years (range: 12–84 years). Male to female ratio was 31:12. Stage was T1, T2 and T3 in 2, 17 and 18 patients respectively. Sixteen patients underwent surgery. Thirty-six patients received RT (14 received definitive RT, 11 had post-operative RT and 11 had RT with palliative intent). Eight patients (16%) received chemotherapy (5 received concurrent with RT, 2 had adjuvant and 1 had neo-adjuvant chemotherapy). Nine patients (of 11 patients) achieved a complete response (CR) and 2 achieved a partial response (PR) after surgery plus post-operative RT. Nine patients and 5 patients respectively achieved CR and PR after definitive RT (with or without concurrent chemotherapy). Of the 11 patients who received palliative RT, 2 had very good objective response (>50%) and 7 patients had PR to palliative RT. After a median follow-up of 16 months, median PFS for the entire cohort was 14 months. Two-year PFS rates were 85.7%, 46.9% and 0% for patients treated with surgery and post-operative RT, definitive RT and palliative RT respectively. On univariate analysis, higher stage ( p = 0.05) and facial nerve palsy at presentation ( p = 0.0008) were significant predictors of inferior PFS. Conclusion Patients with carcinoma of EAC present mostly in advanced stage at our centre. Combined higher stage (T3) and facial nerve palsy at presentation portend poorer outcome. Combined modality treatment with surgery and radiotherapy should be advocated and palliative RT remains a reasonable treatment option in patients with advanced incurable disease.</abstract><cop>Netherlands</cop><pub>Elsevier Ireland Ltd</pub><pmid>26165629</pmid><doi>10.1016/j.anl.2015.06.005</doi><tpages>5</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Antineoplastic Agents - therapeutic use Antineoplastic Combined Chemotherapy Protocols - therapeutic use Cancer Care Facilities Carboplatin - administration & dosage Carcinoma Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - therapy Chemoradiotherapy, Adjuvant Child Cisplatin - therapeutic use Disease-Free Survival Ear Canal - surgery Ear Neoplasms - pathology Ear Neoplasms - therapy External auditory canal Female Head and Neck Neoplasms - pathology Head and Neck Neoplasms - therapy Humans Kaplan-Meier Estimate Lymph Nodes - pathology Male Middle Aged Neck Dissection Neoadjuvant Therapy Neoplasm Staging Otolaryngology Otologic Surgical Procedures Paclitaxel - administration & dosage Prognosis Proportional Hazards Models Radiotherapy Radiotherapy, Adjuvant Retrospective Studies Squamous Cell Carcinoma of Head and Neck Tertiary Care Centers Treatment Outcome Young Adult |
| title | Treatment of squamous cell carcinoma of external auditory canal: A tertiary cancer centre experience |
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