Troschel Fabian M, Steike David Rene, Roers Julian, Kittel Christopher, Siats Jan, Parfitt Ross, Hesping Amélie E, Am Zehnhoff-Dinnesen Antoinette, Neumann Katrin, Eich Hans Theodor, Scobioala Sergiu
Department of Radiation Oncology, Münster University Hospital, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Department of Phoniatrics and Pediatric Audiology, Münster University Hospital, Münster, Germany.
Strahlenther Onkol. 2025 Apr;201(4):438-451. doi: 10.1007/s00066-024-02308-5. Epub 2024 Oct 25.
This study aimed to analyze treatment-related risk factors for sensorineural hearing loss (SNHL) and an indication for hearing aids (IHA) in medulloblastoma patients after craniospinal radiotherapy (CSRT) and platin-based chemotherapy (PCth).
A total of 58 patients (116 ears) with medulloblastoma and clinically non-relevant pre-treatment hearing thresholds were included. Cranial radiotherapy and PCth were applied sequentially according to the HIT 2000 study protocol or post-study recommendations, the NOA-07 protocol, or the PNET (primitive neuroectodermal tumor) 5 MB therapy protocol. Audiological outcomes up to a maximum post-therapeutic follow-up of 4 years were assessed. The incidence, post-treatment progression, and time-to-onset of SNHL, defined as Muenster classification grade ≥MS2b, were evaluated. Risk factors for IHA were analyzed separately.
While 39 patients received conventionally fractionated RT (CFRT; group 1), 19 patients received hyperfractionated RT (HFRT; group 2). Over a median follow-up of 40 months, 69.2% of ears in group 1 experienced SNHL ≥MS2b compared to 89.5% in group 2 (p = 0.017). In multivariable Cox regressions analysis, younger age and increased mean cochlear radiation dose calculated as the equivalent dose in 2‑Gy fractions (EQD2) were associated with time-to-onset of SNHL ≥MS2b (p = 0.019 and p = 0.023, respectively) and IHA (p < 0.001 and p = 0.016, respectively). Tomotherapy and supine positioning were associated with a lower risk for IHA in univariable modelling only (p = 0.048 and p = 0.027, respectively).
Young age and cochlear EQD2 D ≥40 Gy are significant risk factors for the incidence, degree, and time-to-event of SNHL as well as for IHA in medulloblastoma patients.
本研究旨在分析髓母细胞瘤患者在进行颅脊髓放疗（CSRT）和铂类化疗（PCth）后发生感音神经性听力损失（SNHL）的治疗相关危险因素以及助听器使用指征（IHA）。
共纳入58例（116耳）髓母细胞瘤患者，其治疗前听力阈值在临床上无相关性。根据HIT 2000研究方案或研究后推荐方案、NOA - 07方案或PNET（原始神经外胚层肿瘤）5MB治疗方案依次进行颅脑放疗和PCth。评估了最长4年的治疗后随访期内的听力学结果。评估了定义为明斯特分类等级≥MS2b的SNHL的发生率、治疗后进展情况及发病时间。分别分析了IHA的危险因素。
39例患者接受了常规分割放疗（CFRT；第1组），19例患者接受了超分割放疗（HFRT；第2组）。在中位随访40个月时，第1组69.2%的耳发生了≥MS2b的SNHL，而第2组为89.5%（p = 0.017）。在多变量Cox回归分析中，年龄较小以及以2 - Gy分次等效剂量（EQD2）计算的平均耳蜗辐射剂量增加与≥MS2b的SNHL发病时间（分别为p = 0.019和p = 0.023）以及IHA（分别为p < 0.001和p = 0.016）相关。断层放疗和仰卧位仅在单变量模型中与IHA风险较低相关（分别为p = 0.048和p = 0.027）。
年龄较小和耳蜗EQD2≥40 Gy是髓母细胞瘤患者SNHL的发生率、程度和发病时间以及IHA的重要危险因素。
