Bhandare Niranjan, Antonelli Patrick J, Morris Christopher G, Malayapa Robert S, Mendenhall William M
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
Int J Radiat Oncol Biol Phys. 2007 Feb 1;67(2):469-79. doi: 10.1016/j.ijrobp.2006.09.017.
To investigate the incidence of radiation-induced ototoxicity according to the total dose delivered to specific parts of the auditory system, fractionation, and chemotherapy.
Records of 325 patients treated for primary extracranial head and neck tumors with curative intent who received radiotherapy between 1964 and 2000 (median follow-up, 5.4 years) were retrospectively reviewed. Reconstructions of the treatment plans were generated to estimate the doses received by components of the auditory system.
Radiotherapy-induced morbidity developed in 41.8% of patients (external ear, 33.2%; middle ear, 28.6%; and inner ear, 26.8%). Univariate/multivariate analyses indicate that total dose received by parts of the auditory system seem to be significant, though fractionation and chemoradiation may contribute to the incidence of ototoxicities. Sensorineural hearing loss (SNHL) was observed in 49 patients (15.1%). Univariate and multivariate analyses indicated that age (p = 0.0177 and p = 0.005) and dose to cochlea (p < 0.0001 and p < 0.0001) were significant, and chemoradiation (p = 0.0281 and p = 0.006) may increase the incidence of SNHL. Five-year and 10-year actuarial risk of clinically overt SNHL increased to 37% (p > 0.0001) above doses of 60.5 Gy compared to 3% at doses below 60.5 Gy. For patients treated with adjuvant chemotherapy, clinically overt SNHL increased to 30% compared to 18% in the no-chemotherapy group at 10 years (p = 0.0281).
Radiotherapy toxicity was observed in all parts of the auditory system with median doses for incidence varying between 60 Gy to 66 Gy. Total dose to organ seems to be a significant factor though fractionation and chemo-radiation may contribute to ototoxicities.
根据传递至听觉系统特定部位的总剂量、分割方式及化疗情况，调查放射性耳毒性的发生率。
回顾性分析1964年至2000年间接受根治性放疗的325例原发性颅外头颈部肿瘤患者的记录（中位随访时间为5.4年）。生成治疗计划的重建图像以估计听觉系统各组成部分所接受的剂量。
41.8%的患者出现放疗引起的并发症（外耳，33.2%；中耳，28.6%；内耳，26.8%）。单因素/多因素分析表明，听觉系统各部位所接受的总剂量似乎具有显著性，尽管分割方式和放化疗可能会影响耳毒性的发生率。49例患者（15.1%）出现感音神经性听力损失（SNHL）。单因素和多因素分析表明，年龄（p = 0.0177和p = 0.005）以及耳蜗剂量（p < 0.0001和p < 0.0001）具有显著性，放化疗（p = 0.0281和p = 0.006）可能会增加SNHL的发生率。与剂量低于60.5 Gy时的3%相比，剂量高于60.5 Gy时，临床明显SNHL的5年和10年精算风险增加至37%（p > 0.0001）。对于接受辅助化疗的患者，10年时临床明显SNHL增加至30%，而未化疗组为18%（p = 0.0281）。
在听觉系统的所有部位均观察到放疗毒性，发生率的中位剂量在60 Gy至66 Gy之间变化。器官的总剂量似乎是一个重要因素，尽管分割方式和放化疗可能会导致耳毒性。
