|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 4 | Page : 623-624
External auditory canal carcinoma: Impact of chemotherapy
V Noronha, A Joshi, J Ghosh, K Prabhash
Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
|Date of Web Publication||10-Mar-2016|
Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Noronha V, Joshi A, Ghosh J, Prabhash K. External auditory canal carcinoma: Impact of chemotherapy. Indian J Cancer 2015;52:623-4
A 57-year-old male patient with depressive illness on antidepressants for 9 years, without any other comorbidities came to us with history of persistent ear discharge and pain. He was evaluated outside, and was found to have a mass in the external auditory canal (EAC). He underwent radical mastoidectomy outside for his complaints in 24.8.12. Post-operative biopsy from the mass was suggestive of moderately differentiated squamous cell carcinoma. High resolution CT scan of the temporal bone was done after the surgery, which showed post mastoidectomy status. There was an abnormal soft tissue in the left middle ear cavity with dehiscence of facial canal in tympanic segment. In view of residual disease, he underwent adjuvant External Beam Radiotherapy to a dose of 59.4Gy/33#/6.5 weeks. This treatment was completed in November 2012.
Three months following Radiotherapy in February 2013, he was found to be having uptake in the left level II node in PET scan, with no metabolically active disease elsewhere. He presented to us at this point. We performed Fine needle aspiration cytology from the neck node, which was consistent with metastasis. Repeat MRI was done, which showed necrotic lesion seen involving the left superficial parotid gland involving the skin and the left submandibular region. The neck nodes were enlarged. There was evidence of encasement of the internal carotid artery (>270 degrees). As the patient was surgically unresectable and has already received radiation before, he was given palliative chemotherapy with nanopaclitaxel @ 175 mg/m 2 day 1 and carboplatin at AUC5 on day 1, cycle every 21 days, commencing on March 2013. Post 3 cycles, there were no major toxicities. Response assessment with MRI showed partial response. So the patient was continued on three more cycles of same chemo regimen. Post six cycles of chemotherapy, MRI was done which showed partial response compared to post three cycles assessment. The patient's last dose of chemotherapy was on June 2013. As there was persistent disease, he was started on oral metronomic chemotherapy with methotrexate 15 mg/m 2 weekly along with celecoxib 200 mg twice daily from July 2013. He came to us for follow-up in September 2013. Repeat MRI was done, which showed significant increase in the size of the primary lesion. The lesion is depicted in [Figure 1] Multiple necrotic nodes are noted at the left level IB, II, IV and V. Clinically the patient had a fungating mass behind the left pinna along with purulent discharge from the ear. Overall picture was suggestive of progressive disease. The patient is alive with disease on 2nd November 2013.
Squamous cell carcinoma is the commonest histological subtype for external auditory canal carcinoma.
In a study by Moody et al., the 2-year survival rates for primary squamous cell carcinoma of the temporal bone were as follows: T1 lesions 100%, T2 80%, T3 50%, and T4 7%. Survival for T3 tumors was 75% with postoperative radiotherapy, compared with 0% with surgery alone.
In a Chinese study, the 5-year survival rate was 51.7% in patient who were treated with surgery followed by post operative radiotherapy. Similar results were seen in a retrospective analysis by sarkar et al.
In this case, post surgery with adjuvant radiotherapy, the patient progressed within three months. Post surgery, post RT, he is on chemotherapy and disease was controlled for seven months and the patient is still alive. In our case, the patient has stayed alive for nearly eight months after starting chemotherapy. There is no consensus about the systemic therapy in the management of recurrent carcinoma of EAC, neither about the chemotherapy regimens.
There is paucity of data regarding the management of relapsed/refractory carcinoma of EAC. A prolonged survival and response patterns in our case highlights the possible role of chemotherapy in their management. Therefore, studies are warranted to determine the exact impact of chemo in such setting.
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Moody SA, Hirsch BE, Myers EN. Squamous cell carcinoma of the external auditory canal: An evaluation of a staging system. Am J Otol 2000;21:582-8.
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Sarkar SK, Rashid MA, Patra NB, Goswami J. Evaluation of results of radiotherapy alone vs combined surgery and postoperative radiotherapy in carcinoma external auditory canal-10 years review. Indian J Otolaryngol Head Neck Surg 2005;57:312-4.