- 作者：Wan-Yu Chen ; M.D.&lowast ; ; Sung-Hsin Kuo ; M.D. ; Ph.D.&lowast ; ; &dagger ; ; Yu-Hsuan Chen ; M.D.&lowast ; ; Szu-Huai Lu ; B.S.&lowast ; ; Chiao-Ling Tsai ; M.D.&lowast ; ; Jason Chia-Hsien Cheng ; M.D. ; M.S. ; Ph.D.&lowast ; ; &dagger ; ; &Dagger ; ; Ruey-Long Hong ; M.D. ; Ph.D.§ ; ; Ya-Fang Chen ; M.D.¶ ; ; Chuan-Jen Hsu ; M.D. ; Ph.D.?/sup> ; Kai-Nan Lin ; M.D. ; Ph.D.?/sup> ; Jenq-Yuh Ko ; M.D. ; Ph.D.?/sup> ; Pei-Jen Lou ; M.D. ; Ph.D.?/sup> ; Cheng-Ping Wang ; M.D.?/sup> ; Fok-Ching Chong ; Ph.D.&lowast ; &lowast ; ; Chun-Wei Wang ; M.D.&lowast ; &lowast ; ; cwwang@ntuh.gov.tw
- 关键词：Intensity-modulated radiotherapy ; Squamous cell carcinoma ; External auditory canal ; Middle ear ; Marginal miss
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 出版时间：15 March, 2012
- 年：2012
- 卷：82
- 期：4
- 页码：1485-1493
- 全文大小：1000 K
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.