Department of Radiation Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, New York, New York.
Pract Radiat Oncol. 2024 May-Jun;14(3):212-215. doi: 10.1016/j.prro.2023.12.009. Epub 2024 Jan 10.
The cochlear apparatus is one of the major organs at risk when considering radiation therapy (RT) for brain, head, and neck tumors. Radiation oncologists currently consider mean dose constraints of <35 Gy for conventionally fractioned radiation therapy (RT), <4 Gy for single fraction stereotactic radiosurgery, and <17.1 or 25 Gy for 3- or 5-fraction stereotactic radiosurgery, respectively, as the standard of care. Indeed, dose adjustments are made in the setting of concurrent platinum-based chemotherapy or when prioritizing tumor coverage during treatment planning. Despite guidelines, in many patients, RT to the cochlea may still cause sensorineural hearing loss through progressive degeneration and ossification of the inner ear. There are several audiologic and otolaryngologic interventions for incident RT-induced hearing loss, including hearing aids, cochlear implants, or, in the context of vestibular schwannoma due to neurofibromatosis type 2, auditory brain stem implantation. Cochlear implants are the most effective at restoring hearing and improving quality of life for those with an intact cochlear nerve. An early multidisciplinary approach is essential to optimally manage RT-induced hearing loss, and this topic discussion serves as a guide for radiation oncologists on cochlear dosimetric considerations as well as how to address potential RT-induced adverse effects.
当考虑对脑、头颈部肿瘤进行放射治疗（RT）时，耳蜗器官是主要的危险器官之一。放射肿瘤学家目前认为，常规分割放射治疗（RT）的平均剂量限制为 <35 Gy，单次分割立体定向放射外科治疗为 <4 Gy，3 或 5 次分割立体定向放射外科治疗分别为 <17.1 或 25 Gy，这是标准的治疗方法。事实上，在同步铂类化疗或在治疗计划中优先考虑肿瘤覆盖范围时，会进行剂量调整。尽管有指南，但在许多患者中，RT 仍可能导致耳蜗的感音神经性听力损失，这是内耳进行性退化和骨化的结果。有几种听力学和耳鼻喉科干预措施可用于治疗放射性 RT 引起的听力损失，包括助听器、人工耳蜗或在 2 型神经纤维瘤病引起的前庭神经鞘瘤的情况下，听觉脑干植入。对于那些耳蜗神经完整的患者，人工耳蜗是恢复听力和提高生活质量最有效的方法。早期多学科方法对于最佳管理 RT 引起的听力损失至关重要，本主题讨论为放射肿瘤学家提供了耳蜗剂量学考虑因素的指南，以及如何解决潜在的 RT 引起的不良反应。
