Postoperative intensity-modulated radiotherapy for squamous cell carcinoma of the external auditory canal and middle ear: Treatment outcomes, marginal misses, and perspective on target delineation
Journal
International Journal of Radiation Oncology Biology Physics
Journal Volume
82
Journal Issue
4
Pages
1485-1493
Date Issued
2012
Author(s)
Lu S.-H.
Hsu C.-J.
Lin K.-N.
Chong F.-C.
Abstract
Purpose: To report outcomes of the rare disease of squamous cell carcinoma (SCC) of the external auditory canal (EAC) and middle ear treated with surgery and postoperative intensity-modulated radiotherapy (IMRT). Failure patterns related to spatial dose distribution were also analyzed to provide insight into target delineation. Methods and Materials: A retrospective review was conducted of the records of 11 consecutive patients with SCC of the EAC and middle ear who were treated with curative surgery and postoperative IMRT at one institution between January 2007 and February 2010. The prescribed IMRT dose was 60 to 66 Gy at 2 Gy per fraction. Three patients also received concurrent cisplatin-based chemotherapy, and 1 patient received concurrent oral tegafur/uracil. The median follow-up time was 19 months (range, 6-33 months). Results: Four patients had locoregional recurrence, yielding an estimated 2-year locoregional control rate of 70.7%. Among them, 1 patient had persistent disease after treatment, and 3 had marginal recurrence. Distant metastasis occurred in 1 patient after extensive locoregional recurrence, yielding an estimated 2-year distant control rate of 85.7%. The estimated 2-year overall survival was 67.5%. The three cases of marginal recurrence were near the preauricular space and glenoid fossa of the temporomandibular joint, adjacent to the apex of the ear canal and glenoid fossa of the temporomandibular joint, and in the postauricular subcutaneous area and ipsilateral parotid nodes, respectively. Conclusions: Marginal misses should be recognized to improve target delineation. When treating SCC of the EAC and middle ear, care should be taken to cover the glenoid fossa of the temporomandibular joint and periauricular soft tissue. Elective ipsilateral parotid irradiation should be considered. The treatment planning procedure should also be refined to balance subcutaneous soft-tissue dosimetry and toxicity. Copyright ? 2012 Elsevier Inc. Printed in the USA. All rights reserved.
SDGs
Other Subjects
External auditory canals; Intensity-modulated radiotherapy; Marginal miss; Middle ears; Squamous cell carcinoma; Chemotherapy; Diseases; Hydraulic structures; Platinum compounds; Radiotherapy; Surgery; Tissue; Physical therapy; bevacizumab; carboplatin; cisplatin; fluorouracil; UFT; acute toxicity; adult; aged; article; auditory canal; cancer recurrence; cancer surgery; clinical article; continuous infusion; external auditory canal squamous cell carcinoma; female; follow up; human; intensity modulated radiation therapy; male; mastoidectomy; metastasis; middle ear squamous cell carcinoma; multiple cycle treatment; overall survival; parotidectomy; postoperative period; priority journal; radiation dose distribution; squamous cell carcinoma; temporomandibular joint; treatment failure; treatment outcome; tympanoplasty; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Ear Canal; Ear Neoplasms; Ear, Middle; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Postoperative Care; Radiotherapy Setup Errors; Radiotherapy, Intensity-Modulated; Rare Diseases; Treatment Outcome
Type
journal article