{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T10:06:45Z","timestamp":1779790005456,"version":"3.53.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,26]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Few studies have evaluated the efficacy of proton beam therapy (PBT) for external auditory canal cancer (EACC) or middle ear cancer (MEC). Therefore, the present study aimed to evaluate the efficacy and toxicity of PBT for EACC and MEC. Between December 2009 and August 2018, 15 patients (seven males and eight females) underwent PBT for EACC or MEC. The median patient age was 64\u00a0years (range: 40\u201382\u00a0years). Ten patients had EACC, and five patients had MEC. PBT was administered using the passive scattering method. The median total dose of the BED10 was 88.8\u00a0Gy relative biological effectiveness (RBE) (range\u2009=\u200985.6\u201399.3\u00a0Gy [RBE]), administered in 2\u00a0Gy fractions (EQD2) (\u03b1\/\u03b2\u2009=\u200910). Chemotherapy was conducted in 14 patients, systemic chemotherapy in five and intra-arterial infusion chemotherapy in nine. The median follow-up period for all patients was 60\u00a0months (range: 7\u2013136\u00a0months). The 3-year overall survival, local control and progression free survival rates were 65%, 66.7% and 53.3%, respectively. Four patients had grade 3 hearing impairment owing to late toxicity. However, these patients had hearing impairment before treatment as well. No grade 4 or higher late toxicity was observed during the follow-up period. PBT is an effective treatment for EACC and MEC with tolerable toxicity, including in the setting of combined chemotherapy.<\/jats:p>","DOI":"10.1093\/jrr\/rrag024","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T12:53:39Z","timestamp":1773838419000},"page":"444-452","source":"Crossref","is-referenced-by-count":0,"title":["Proton beam therapy for external auditory canal and middle ear cancers"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1089-4431","authenticated-orcid":false,"given":"Masanori","family":"Machida","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9711-1158","authenticated-orcid":false,"given":"Takashi","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Yamagata University , 2-2-2 Iida-Nishi, Yamagata City, Yamagata 990-9585 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koki","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rei","family":"Nishikawa","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuntao","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Tominaga","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Azami","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9227-1366","authenticated-orcid":false,"given":"Yoshiaki","family":"Takagawa","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7083-5877","authenticated-orcid":false,"given":"Motohisa","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Seto","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanako","family":"Takayama","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuhiko","family":"Nakasato","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9530-0337","authenticated-orcid":false,"given":"Masao","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center , 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"2026052605523368600_ref1","doi-asserted-by":"publisher","first-page":"178","DOI":"10.4143\/crt.2016.165","article-title":"Tumor stage-related role of radiotherapy in patients with an external auditory canal and middle ear carcinoma","volume":"49","author":"Choi","year":"2017","journal-title":"Cancer Res Treat"},{"key":"2026052605523368600_ref2","first-page":"582","article-title":"Squamous cell carcinoma of the external auditory canal: an evaluation of a staging system","volume":"21","author":"Moody","year":"2000","journal-title":"Am J Otol"},{"key":"2026052605523368600_ref3","volume-title":"Manuel Pratique De Chirurgie Otologique","author":"Portmann","year":"1997"},{"key":"2026052605523368600_ref4","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1007\/s12105-018-0908-4","article-title":"Squamous cell carcinoma of the external auditory canal and temporal bone: an update","volume":"12","author":"Allanson","year":"2018","journal-title":"Head Neck Pathol"},{"key":"2026052605523368600_ref5","doi-asserted-by":"publisher","first-page":"E949","DOI":"10.1002\/hed.24133","article-title":"Concomitant chemoradiotherapy for advanced squamous cell carcinoma of the temporal bone","volume":"38","author":"Shinomiya","year":"2016","journal-title":"Head Neck"},{"key":"2026052605523368600_ref6","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1002\/lary.24908","article-title":"Arterial chemoradiotherapy for carcinomas of the external auditory canal and middle ear","volume":"125","author":"Fujiwara","year":"2015","journal-title":"Laryngoscope"},{"key":"2026052605523368600_ref7","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1016\/j.tripleo.2007.07.031","article-title":"A new method of selective intra-arterial infusion therapy via the superficial temporal artery for head and neck cancer","volume":"105","author":"Fuwa","year":"2008","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"2026052605523368600_ref8","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.radonc.2014.03.005","article-title":"Retrograde superselective intra-arterial chemotherapy and daily concurrent radiotherapy for stage III and IV oral cancer: analysis of therapeutic results in 112 cases","volume":"111","author":"Mitsudo","year":"2014","journal-title":"Radiother Oncol"},{"key":"2026052605523368600_ref9","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00432-015-2069-0","article-title":"Treatment results of alternating chemoradiotherapy followed by proton beam therapy boost combined with intra-arterial infusion chemotherapy for stage III\u2013IVB tongue cancer","volume":"142","author":"Takayama","year":"2016","journal-title":"J Cancer Res Clin Oncol"},{"key":"2026052605523368600_ref10","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1093\/jjco\/hyv160","article-title":"Preliminary results of proton beam therapy combined with weekly cisplatin intra-arterial infusion via a superficial temporal artery for treatment of maxillary sinus carcinoma","volume":"46","author":"Nakamura","year":"2016","journal-title":"Jpn J Clin Oncol"},{"key":"2026052605523368600_ref11","doi-asserted-by":"publisher","first-page":"333","DOI":"10.3390\/cancers10090333","article-title":"Proton beam therapy in combination with intra-arterial infusion chemotherapy for T4 squamous cell carcinoma of the maxillary gingiva","volume":"10","author":"Endo","year":"2018","journal-title":"Cancers"},{"key":"2026052605523368600_ref12","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1118\/1.595974","article-title":"Proton beam penumbra: effects of separation between patient and beam modifying devices","volume":"13","author":"Urie","year":"1986","journal-title":"Med Phys"},{"key":"2026052605523368600_ref13","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1002\/hed.23905","article-title":"Carbon ion radiotherapy for locally advanced squamous cell carcinoma of the external auditory canal and middle ear","volume":"38","author":"Koto","year":"2016","journal-title":"Head Neck"},{"key":"2026052605523368600_ref14","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1002\/cam4.1830","article-title":"A retrospective multicenter study of carbon-ion radiotherapy for external auditory canal and middle ear carcinomas","volume":"8","author":"Hayashi","year":"2019","journal-title":"Cancer Med"},{"key":"2026052605523368600_ref15","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.3390\/cancers11101413","article-title":"Proton beam therapy combined with intra-arterial infusion chemotherapy for stage IV adenoid cystic carcinoma of the base of the tongue","volume":"11","author":"Takayama","year":"2019","journal-title":"Cancers (Basel)"},{"key":"2026052605523368600_ref16","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.oraloncology.2015.04.005","article-title":"Adenoid cystic carcinoma of the head and neck\u2014an update","volume":"51","author":"Coca-Pelaz","year":"2015","journal-title":"Oral Oncol"},{"key":"2026052605523368600_ref17","doi-asserted-by":"publisher","first-page":"1326","DOI":"10.1016\/j.ijrobp.2007.01.052","article-title":"Treatment and prognosis of squamous cell carcinoma of the external auditory canal and middle ear: a multi-institutional retrospective review of 87 patients","volume":"68","author":"Ogawa","year":"2007","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2026052605523368600_ref18","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1002\/hed.23698","article-title":"Chemoradiation therapy for squamous cell carcinoma of the external auditory canal: a meta-analysis","volume":"37","author":"Takenaka","year":"2015","journal-title":"Head Neck"},{"key":"2026052605523368600_ref19","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.clon.2006.03.001","article-title":"Primary radical radiotherapy for squamous cell carcinoma of the middle ear and external auditory canal\u2014an historical series","volume":"18","author":"Pemberton","year":"2006","journal-title":"Clin Oncol (R Coll Radiol)"},{"key":"2026052605523368600_ref20","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1177\/107327481602300315","article-title":"Hypofractionated stereotactic radiotherapy for auditory canal or middle ear cancer","volume":"23","author":"Murai","year":"2016","journal-title":"Cancer Control"},{"key":"2026052605523368600_ref21","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1111\/j.1365-2273.1984.tb01511.x","article-title":"Carcinoma of the external auditory meatus and middle ear","volume":"9","author":"Stell","year":"1984","journal-title":"Clin Otolaryngol Allied Sci"},{"key":"2026052605523368600_ref22","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1177\/019459989411000303","article-title":"Efficacy of surgical treatments for squamous cell carcinoma of the temporal bone: a literature review","volume":"110","author":"Prasad","year":"1994","journal-title":"Otolaryngol Head Neck Surg"},{"key":"2026052605523368600_ref23","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.anorl.2012.08.003","article-title":"Cancer of the external auditory canal","volume":"130","author":"Ouaz","year":"2013","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"key":"2026052605523368600_ref24","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1002\/hed.20877","article-title":"Cancer of the external auditory canal and middle ear in Denmark from 1992 to 2001","volume":"30","author":"Madsen","year":"2008","journal-title":"Head Neck"},{"key":"2026052605523368600_ref25","doi-asserted-by":"publisher","first-page":"3487","DOI":"10.1007\/s00405-019-05627-x","article-title":"Anterolateral thigh free flap in reconstruction of lateral skull base defects after oncological resection","volume":"276","author":"Trojanowski","year":"2019","journal-title":"Eur Arch of Otorhinolaryngol"},{"key":"2026052605523368600_ref26","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.ijrobp.2014.02.029","article-title":"Proton radiation therapy for head and neck cancer: a review of the clinical experience to date","volume":"89","author":"Holliday","year":"2014","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2026052605523368600_ref27","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.anl.2005.11.012","article-title":"Analysis of 95 cases of squamous cell carcinoma of the external and middle ear","volume":"33","author":"Yin","year":"2006","journal-title":"Auris Nasus Larynx"},{"key":"2026052605523368600_ref28","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1200\/JCO.2005.03.168","article-title":"Supradose intra-arterial cisplatin and concurrent radiation therapy for the treatment of stage IV head and neck squamous cell carcinoma is feasible and efficacious in a multi-institutional setting: results of radiation therapy oncology group trial 9615","volume":"23","author":"Robbins","year":"2005","journal-title":"J Clin Oncol"},{"key":"2026052605523368600_ref29","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1002\/cncr.25577","article-title":"Intra-arterial chemotherapy for head and neck cancer: is there a verdict?","volume":"117","author":"Rasch","year":"2011","journal-title":"Cancer"}],"container-title":["Journal of Radiation Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jrr\/article-pdf\/67\/3\/444\/68137957\/rrag024.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jrr\/article-pdf\/67\/3\/444\/68137957\/rrag024.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T09:52:39Z","timestamp":1779789159000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jrr\/article\/67\/3\/444\/8661029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,4,22]]},"published-print":{"date-parts":[[2026,5,26]]}},"URL":"https:\/\/doi.org\/10.1093\/jrr\/rrag024","relation":{},"ISSN":["0449-3060","1349-9157"],"issn-type":[{"value":"0449-3060","type":"print"},{"value":"1349-9157","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,4,22]]}}}