Chan S H, Ng W T, Kam K L, Lee Michael C H, Choi C W, Yau T K, Lee Anne W M, Chow S K
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
Int J Radiat Oncol Biol Phys. 2009 Apr 1;73(5):1335-42. doi: 10.1016/j.ijrobp.2008.07.034. Epub 2008 Oct 14.
To analyze the effects of radiotherapy (RT) and chemotherapy in relation to sensorineural hearing loss (SNHL) after contemporary treatment of nasopharyngeal carcinoma.
A total of 87 nasopharyngeal carcinoma patients were treated with RT or chemoradiotherapy using either three-dimensional conformal RT or intensity-modulated RT between 2004 and 2005. Tympanometry and pure-tone audiogram assessments were performed before treatment and then serially at 6-month intervals. The dose-volume data of the cochlea were analyzed. The effects of cisplatin administered in concurrent and nonconcurrent phases was explored.
Of the 170 eligible ears, RT (n = 30) and chemoradiotherapy (n = 140) resulted in 40% (n = 12) and 56.4% (n = 79) persistent SNHL (> or = 15 dB loss), respectively, after a median follow-up of 2 years. SNHL at a high frequency was more frequent statistically in the chemoradiotherapy group than in the RT-alone group (55% vs. 33.3%, p < 0.01), but not at a low frequency (7.9% vs. 16.7%, p = 0.14). Within the chemoradiotherapy group, the mean cochlea dose and concurrent cisplatin dose were important determinants of high-frequency SNHL, with an odds ratio of 1.07/Gy increase (p = 0.01) and an odds ratio of 1.008/mg/m(2) increase (p < 0.01), respectively. Age, gender, and nonconcurrent cisplatin dose were not statistically significant factors. A mean radiation dose to the cochlea of <47 Gy would result in <15% of patients developing severe (> or = 30 dB) high-frequency SNHL.
The results of our study have shown that high-frequency SNHL is significantly related to the mean cochlea dose and the concurrent cisplatin dose. A mean dose constraint of 47 Gy to the cochlea is recommended to minimize SNHL after chemoradiotherapy.
分析放射治疗（RT）和化疗对当代鼻咽癌治疗后感音神经性听力损失（SNHL）的影响。
2004年至2005年期间，共有87例鼻咽癌患者接受了三维适形放疗或调强放疗的RT或放化疗。在治疗前进行鼓室图和纯音听力图评估，然后每隔6个月进行一次。分析了耳蜗的剂量体积数据。探讨了顺铂在同步和非同步阶段给药的效果。
在170只符合条件的耳朵中，RT组（n = 30）和放化疗组（n = 140）在中位随访2年后分别有40%（n = 12）和56.4%（n = 79）出现持续性SNHL（听力损失≥15 dB）。放化疗组高频SNHL在统计学上比单纯RT组更常见（55%对33.3%，p < 0.01），但低频情况并非如此（7.9%对16.7%，p = 0.14）。在放化疗组中，平均耳蜗剂量和同步顺铂剂量是高频SNHL的重要决定因素，每增加1 Gy的比值比为1.07（p = 0.
