Ho Jason C S, Ma Brigette B Y, Chow James C H
Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China.
Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China.
Cancers (Basel). 2024 Sep 23;16(18):3237. doi: 10.3390/cancers16183237.
Intensity-modulated radiation therapy (IMRT) improves disease control and reduces treatment-related toxicity in patients with localized nasopharyngeal carcinoma (NPC). However, due to the proximity of the auditory apparatus to the treatment volume and the frequent incorporation of cisplatin-based chemotherapy, treatment-related sensorineural hearing loss (SNHL) remains a common debilitating complication among NPC survivors. The reported crude incidence of SNHL following IMRT for NPC varies widely at 1-46% due to differences in auditory assessment methods and thresholds, follow-up durations, chemotherapy usage, and patient compositions. International guidelines and radiation dosimetric studies have recommended constraining the cochlear mean dose to less than 44-50 Gy, but the risk of SNHL remains high despite adherence to these constraints. Potential strategies to improve hearing outcomes in NPC survivors include cautious de-escalation of radiotherapy dose and volume, individualization of cochlear constraints, optimization of radiotherapy planning techniques, and the use of substitutes or alternative schedules for cisplatin-based chemotherapy. The addition of immune checkpoint inhibitors to chemoradiotherapy did not impact ototoxicity. Prospective studies that employ both objective and patient-reported auditory outcomes are warranted to test the long-term benefits of various approaches. This article aims to provide a comprehensive review of the incidence and radiation dose-toxicity relationship of SNHL in NPC survivors and to summarize potential strategies to optimize hearing outcomes in relation to nuances in radiotherapy planning and the selection of systemic therapy.
调强放射治疗（IMRT）可改善局部鼻咽癌（NPC）患者的疾病控制情况，并降低与治疗相关的毒性。然而，由于听觉器官靠近治疗区域，且常联合使用以顺铂为基础的化疗，治疗相关的感音神经性听力损失（SNHL）仍是NPC幸存者中常见的致残性并发症。由于听觉评估方法和阈值、随访时间、化疗使用情况及患者构成存在差异，报道的NPC患者IMRT后SNHL的粗发病率差异很大，为1%-46%。国际指南和放射剂量学研究建议将耳蜗平均剂量限制在44-50 Gy以下，但即便遵循这些限制，SNHL的风险仍然很高。改善NPC幸存者听力结果的潜在策略包括谨慎降低放疗剂量和体积、个性化耳蜗限制、优化放疗计划技术，以及使用顺铂化疗的替代药物或替代方案。在放化疗中添加免疫检查点抑制剂对耳毒性没有影响。有必要开展采用客观和患者报告的听觉结果的前瞻性研究，以检验各种方法的长期益处。本文旨在全面综述NPC幸存者中SNHL的发病率及放射剂量-毒性关系，并总结与放疗计划细微差别和全身治疗选择相关的优化听力结果的潜在策略。
