BACKGROUND: There is no consensus regarding the indication for postoperative radiotherapy (PORT) for T1- and T2-classified squamous cell carcinoma (SCC) of the external auditory canal (EAC) even with negative surgical margins. This study aimed to evaluate whether PORT provides additional benefits for these cases. METHODS: We collected retrospective data from fourteen international hospitals, including resected pT1- and pT2-classified EAC SCC with negative surgical margins. RESULTS: A total of 112 early-stage radically resected EAC SCC were included, with 48 patients receiving PORT. The 5-year DFS of T1- and T2-classified EAC SCC treated with PORT was not statistically significantly different (92.9% and 76.9%, respectively) compared to the group treated without PORT (100% and 90.9%, respectively; p-values of 0.999 and 0.526, respectively). EAC SCC treated with PORT more frequently exhibited perineural and angioinvasive growth. Eighteen patients experienced side effects related to radiotherapy, of which one patient developed osteoradionecrosis. CONCLUSIONS: Our study suggests that PORT for early-stage radically resected EAC SCC should only be considered in selected cases with perineural, infiltrative growth or angioinvasive growth, and with a close margin. This approach helps mitigate the negative impact on quality of life and the risk of side effects associated with radiotherapy.

Department of Head and Neck Surgery and Oncology Netherlands Cancer Institute Antoni van Leeuwenhoek 1066 CX Amsterdam The Netherlands

Department of Head and Neck Surgery Lariboisière University Hospital 75010 Paris France

Department of Head and Neck Surgical Oncology University Medical Center Utrecht Cancer Center 3584 CG Utrecht The Netherlands

Department of Health Evidence Radboud University Medical Center 6525 GA Nijmegen The Netherlands

Department of Otolaryngology Head and Neck Surgery Amsterdam University Medical Centers VU University 1081 HV Amsterdam The Netherlands

Department of Otology and Skull Base Surgery Eye Ear Nose and Throat Hospital Fudan University Shanghai 200437 China

Department of Otorhinolaryngology and Head and Neck Surgery Academic Alliance Skull Base Pathology Radboudumc and MUMC Maastricht University Medical Center 6229 HX Maastricht The Netherlands

Department of Otorhinolaryngology and Head and Neck Surgery Academic Alliance Skull Base Pathology Radboudumc and MUMC Radboud University Medical Center 6525 GA Nijmegen The Netherlands

Department of Otorhinolaryngology and Head and Neck Surgery Erasmus Medical Center 3015 GD Rotterdam The Netherlands

Department of Otorhinolaryngology and Head and Neck Surgery Leiden University Medical Center 2333 ZA Leiden The Netherlands

Department of Otorhinolaryngology and Head and Neck Surgery University Medical Center of Groningen University of Groningen 9713 GZ Groningen The Netherlands

Department of Otorhinolaryngology and Skull Base Microsurgery Neurosciences Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII 24127 Bergamo Italy

Department of Otorhinolaryngology Head and Neck Surgery Cambridge University Hospitals NHS Foundation Trust Cambridge CB2 0QQ UK

Department of Otorhinolaryngology Head and Neck Surgery Haaglanden Medical Center 2512 HH The Hage The Netherlands

Department of Otorhinolaryngology Head and Neck Surgery The 1st Faculty of Medicine Charles University Prague University Hospital Motol 150 06 Prague Czech Republic

Department of Radiation Oncology Radboud University Medical Center 6525 GA Nijmegen The Netherlands

Rare Cancers Radboud Institute for Health Sciences 6525 EZ Nijmegen The Netherlands

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