Carcinoma of the external auditory canal and middle ear

Fifty-three patients with carcinoma arising in the external auditory canal and/or middle ear seen at Veterans General Hospitals, Taipei and Taichung in the period between January 1970 and December 1988 were retrospectively reviewed. There were 49 males and 4 females. Their ages ranged from 5 to 80 years, the average being 58 and the median 59 years. In 10 patients the primary site of the tumor was located in the middle ear, in 32 patients it was the external auditory canal, and in the remaining 11, both areas. The most common cancer which occurred in this area was the squamous cell type, accounting for 85% of our cases. The majority of patients had an otorrhea history with duration from 6 months to more than 40 years. Nine patients received surgery alone, 8 irradiation alone, 31 a combination of surgery and radiotherapy. Initial complete regression of the tumor was noted in 100% of the combined therapy group. This was better than surgery (56%) or irradiation alone (60%). Bleeding and infection caused by surgery, and osteonecrosis caused by radiation were the most frequent and severe complications. The actual 5-year survival rate was 33%. Life table analysis showed that only the extent of the disease affected survival significantly. The 5-year survival rates were 23% and 51% for advanced and early stages respectively (p < 0.05). Combined therapy resulted in better local control and survival than operation or radiotherapy alone, but the benefit did not reach a significant level (p = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)