Purpose: To investigate the role of radiotherapy for squamous cell carcinomas of the external auditory canal and middle ear.Materials and Methods: A series of 35 patients who were treated at a single institution from 1981 through 2007 were retrospectively analyzed.Thirteen patients were treated by radiotherapy alone; four by surgery only and 18 by a combination of surgery and radiotherapy.The total radiation dose ranged from 39∼70 Gy (median, 66 Gy) in 13∼35 fractions for radiotherapy alone and 44∼70 Gy (median, 61.2 Gy) in 22∼37 fractions for the combined therapy.Clinical end-points were the cause of specific survival (CSS) and local relapse-free survival (LRFS).The median follow-up time was 2.8 years (range, 0.2∼14.6years).Results: The 3-year CSS and LRFS rate was 80% and 63%, respectively.Based on a univariate analysis, performance status and residual disease after treatment had a significant impact on CSS; performance status and histologic grade for LRFS.Patients treated by radiotherapy alone had more residual disease following the course of treatment compared to patients treated with the combined therapy; 69% vs. 28%, respectively.Conclusion: Our results suggest that radiation alone was not an inferior treatment modality for CSS compared to the combined therapy for squamous cell carcinoma of the external auditory canal and middle ear.However, local failure after radiotherapy is the main issue that will require further improvement to gain optimal local control.
Purpose This study evaluates the long-term results of definitive radiotherapy (RT) for early glottic cancer. Clinical and treatment factors related to local control and patterns of failure are analyzed. Materials and Methods We retrospectively reviewed 222 patients with T1-2N0 squamous cell carcinoma of the glottic larynx treated with definitive RT from 1981 to 2010. None of the patients received elective nodal RT or combined chemotherapy. The median total RT dose was 66 Gy. The daily fraction size was < 2.5 Gy in 69% and 2.5 Gy in 31% of patients. The RT field extended from the hyoid bone to the cricoid cartilage. Results The median age was 60 years, and 155 patients (70%) had T1 disease. The 5-year rates of local recurrence-free survival (LRFS) and ultimate LRFS with voice preservation were 87.8% and 90.3%, respectively. T2 (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.08 to 4.94) and anterior commissural involvement (HR, 3.37; 95% CI, 1.62 to 7.02) were significant prognostic factors for LRFS. In 34 patients with local recurrence, tumors recurred in the ipsilateral vocal cord in 28 patients. There were no contralateral vocal cord recurrences. Most acute complications included grade 1-2 dysphagia and/or hoarseness. There was no grade 3 or greater chronic toxicity. Conclusion Definitive RT achieved a high cure rate, voice preservation, and tolerable toxicity in early glottic cancer. T2 stage and anterior commissural involvement were prognostic factors for local control. Further optimization of the RT method is needed to reduce the risk of ipsilateral tumor recurrence. Key words: Laryngeal neoplasms, Glottis, Squamous cell carcinoma, Radiation therapy, Risk factors, Local neoplasm recurrence
Purpose: We performed an immunohistochemical study with pre-treatment biopsy specimens to evaluate the prognostic significance of four biomolecular markers which can be used as a predictive assay for radiotherapy (RT) treatment of nasopharyngeal carcinoma (NPC).Materials and Methods: From January 1998 through December 2006, 68 patients were histologically diagnosed as non-metastatic NPC and treated by RT.Only 38 patients had the paraffin block for the immunohistochemical study.Thirty-one patients had undifferentiated carcinoma and 7 patients had squamous cell carcinoma.Thirtytwo patients (84%) had advanced stage NPC (2002 AJCC Stage III∼IV).Immunohistochemical staining was performed for Met, COX-2, nm23-H1, and epidermal growth factor receptor (EGFR) expression using routine methods.Results: The median follow-up time was 30 months (range, 11 to 83 months) for all patients, and 39 months (range, 19 to 83 months) for surviving patients.The 5-year overall survival (OS) rate of the patients with high Met extent (≥50%) was significantly lower than that of the patients with low Met extent (48% vs. 84%, p=0.02).In addition, Met extent was also a significant prognostic factor in multivariate analysis (p=0.01).No correlation was observed between Met extent and T stage, N stage, stage group, gender, age, and the response to chemotherapy or RT.Met extent showed moderate correlation with COX-2 expression (Pearson coefficient 0.496, p＜0.01), but COX-2 expression did not affect OS.Neither nm23-H1 or EGFR expression was a prognostic factor for OS in this study.Conclusion: High Met extent (≥50%) might be an independent prognostic factor that predicts poor OS in NPC treated with RT.
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