Lokeswari A, Bahl Amit, Banumathy N, Bakshi Jaimanti, Mohindra Satyawati, Gupta Rijuneeta, Sushmita Ghoshal, Singh Oinam Arun, Singh Ranjit, Panda Naresh Kumar
Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Otolaryngol Head Neck Surg. 2025 Apr;77(4):1727-1733. doi: 10.1007/s12070-025-05338-2. Epub 2025 Mar 6.
This study evaluates the impact of reduction of radiotherapy dose received by cochlea on hearing loss in oropharyngeal cancer patients treated by concurrent cisplatin chemoradiotherapy using simultaneous Integrated Boost Volumetric Modulated Arc Therapy (SIB-VMAT). Sixty ears were evaluated in this prospective non blinded randomized trial. The study group (=30) was treated with concurrent chemoradiotherapy using Image Guided Radiotherapy with Simultaneous Integrated Boost-Volumetric Modulated Arc technique. The matched control group (=30) received concurrent chemoradiotherapy using 3D conformal radiotherapy (3DCRT). Concurrent chemotherapy was given to all patients with injection Cisplatinum 100 mg/m2 on D1,22&43 along with radiotherapy. Baseline hearing evaluation was done using puretone, impedence and high frequency audiometry. The tests were repeated at 6 months follow up to evaluate hearing loss. The mean radiotherapy dose received by the right and left cochlea in the 3DCRT and SIB-VMAT techniques was 38.99±4.78 versus 6.97±6.09 Gy (mean±SD) (=0.001) and 38.59±5.10 versus 6.79±5.76 Gy (=0.001). At 6 months of follow up sensorineural hearing loss was observed in 66.7 versus 0% (=0.001) and 86.7 versus 6.7% (=0.001) in the right and left ear in the 3DCRT and SIB-VMAT groups.High risk PTV 66 volume more than 300 cc was associated with a higher risk of hearing loss with odds ratio of 6.05 (95% CI 0.54-67.53) and 4.41(95% CI 0.52-37.16) in right and left ear. Age more than fifty years was associated with significant hearing loss in the right ear with an odds ratio of 12.56 (95% CI 0.84-187.87) (=0.02) and 7.38 (95% CI 0.74-73.59) for the left ear. The study shows that reduction in radiotherapy dose received by cochlea is an independent determinant in reducing ototoxicity in the setting of concurrent single agent cisplatin chemotherapy. High risk PTV volume more than 300 cc was associated with a significant increase in hearing loss and PTV 66 volume emerged as a predictive factor for treatment related hearing loss.
本研究评估了在使用同步整合加量容积调强弧形放疗（SIB-VMAT）的顺铂同步放化疗治疗口咽癌患者中，耳蜗所接受放疗剂量的降低对听力损失的影响。在这项前瞻性非盲随机试验中，对60只耳朵进行了评估。研究组（n=30）采用图像引导放疗联合同步整合加量-容积调强弧形技术进行同步放化疗。匹配的对照组（n=30）采用三维适形放疗（3DCRT）进行同步放化疗。所有患者在放疗的第1、22和43天静脉注射顺铂100mg/m²进行同步化疗。使用纯音、声阻抗和高频听力测定法进行基线听力评估。在6个月随访时重复这些测试以评估听力损失。3DCRT和SIB-VMAT技术中，左右耳蜗接受的平均放疗剂量分别为38.99±4.78 Gy与6.97±6.09 Gy（均值±标准差）（P=0.001），以及38.59±5.10 Gy与6.79±5.76 Gy（P=0.001）。在6个月随访时，3DCRT组和SIB-VMAT组右耳感音神经性听力损失的发生率分别为66.7%和0%（P=0.001），左耳分别为86.7%和6.7%（P=0.001）。高危计划靶区（PTV）66体积超过300cc与听力损失风险增加相关，右耳和左耳的比值比分别为6.05（95%可信区间0.54-67.53）和4.41（95%可信区间0.52-37.16）。年龄超过50岁与右耳显著的听力损失相关，比值比为12.56（95%可信区间0.84-187.87）（P=0.02），左耳为7.38（95%可信区间0.74-73.59）。该研究表明，在同步单药顺铂化疗的情况下，降低耳蜗接受的放疗剂量是降低耳毒性的一个独立决定因素。高危PTV体积超过300cc与听力损失的显著增加相关，并且PTV 66体积成为治疗相关听力损失的一个预测因素。
