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Auris Nasus Larynx
Clinical management for T1 and T2 external auditory canal cancer$,$$
Hirotaka Shinomiya *, Natsumi Uehara, Masanori Teshima, Akinori Kakigi, Naoki Otsuki, Ken-ichi Nibu
Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
Article history:
Keywords:
External auditory canal cancer
Temporal bone cancer
Lateral temporal bone resection
Parotidectomy
Postoperative radiotherapy 
Objective: The purpose of this study was to clarify the impact of superficial parotidectomy and postoperative radiotherapy (PORT) for the surgical treatment of early stage squamous cell carcinoma (SCC) in external auditory canal (EAC).
Materials and methods: Thirty-seven patients with T1 (n = 14) or T2 (n = 19) SCC in EAC treated between 2000 and 2016 at Kobe University Hospital were enrolled in this study. Thirty-three patients were operated with sleeve resection or lateral temporal bone resection.
Results: The 5-year overall survival and disease-specific survival rates were 95% and 100%, respectively. Surgical margin was positive in 4 patients, who were treated by PORT and have been alive without disease. Prophylactic superficial parotidectomy was simultaneously performed at the time of initial surgery in 15 patients, in whom no Bafilomycin A1 node (LN) metastasis was observed. Among the other 22 patients, regional recurrence in parotid LN was observed in one patient, who was successfully salvaged by total parotidectomy. Potential parotid lymph node metastasis rates of T1 and T2 SCC in EAC was 0% (0/14) and 5% (1/19) respectively.
Conclusions: Complete resection without positive surgical margins is essential for the treatment of the patients with T1 and T2 ear cancers. Prophylactic superficial parotidectomy or neck dissection is not mandatory for T1 and T2 diseases, as long as precisely extent of disease is assessed preoperatively. PORT should be performed for the patients with positive surgical margins. Levels of evidence: 4.
1. Introduction
Squamous cell carcinoma of the external auditory canal (EAC) is extremely rare with an annual incidence estimated at between 1 to 6 cases per million of the populations [1]. For early
$ This research is partially supported by the grant from Japan Agency for Medical Research and Development (Grant#:17ck0106223h0002).
$$ None of authors report any conflict of interest related to this manuscript.
* Corresponding author at: Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine.7-5-1 Kusunoki-Cho, Chuo-Ku, Hyogo Kobe, 650-0017, Japan.
E-mail address: [email protected] (H. Shinomiya). 
stages T1 and T2, as defined by the modified Pittsburgh staging system [2], sleeve resection of the external canal or en bloc lateral temporal bone resection (LTBR), have yielded favorable oncological and functional results and are the treatment of choice at most institutions [3–5]. According to the United Kingdom National Multidisciplinary Guidelines published in 2016 [6], LTBR is regarded as the minimum oncologic operation for T1 and T2 lesions. Prophylactic superficial or total parotidectomy is recommended for all resections. Post-operative radiotherapy (RT) or chemoradiotherapy (CRT) is recommended for most T2-T4 disease, with the exception of T1 and selected T2 without particularly peri-neural infiltration and with clear margins. However, these guidelines were based on