Kwong D L, Wei W I, Sham J S, Ho W K, Yuen P W, Chua D T, Au D K, Wu P M, Choy D T
Department of Radiotherapy and Oncology, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Int J Radiat Oncol Biol Phys. 1996 Sep 1;36(2):281-9. doi: 10.1016/s0360-3016(96)00302-1.
The pattern of sensorineural hearing loss (SNHL) after primary treatment for nasopharyngeal carcinoma (NPC) was studied, and the effect of cisplatin, radiotherapy does, and fractionation were evaluated.
One hundred thirty-two patients, 227 ears, and 1100 audiogram reports were analyzed. Radiotherapy dose ranged from 59.5 to 76.5 Gy. Fifty-two patients received preirradiation cisplatin, total dose 100-185 mg/m(2). Serial postirradiation bone conduction thresholds at 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz were compared with pretreatment thresholds at respective frequencies. Increase of at least 15 dB was considered as significant and was further grouped as transient or persistent SNHL. Univariate and multivariate analyses were performed to identify predicting factors for persistent SNHL.
At median follow-up of 30 months, 24.2% of ears developed persistent SNHL. High frequency was more affected than low frequencies, 22 vs. 5.3%. Males were more affected than females, 29.4 vs. 15.5%, p = 0.0132. Incidence of persistent SNHL increased with age, with 0, 17.2, and 37.4% of patients aged under 30, between 30-50 and over 50 affected, respectively, p = 0.0001. High incidence was found in patient with postirradiation serous otitis media (SOM), 46.9%. Chemotherapy with cisplatin and radiation dose or fractionation had no significant effect. Multivariate analysis confirmed age, sex, and postirradiation SOM as significant prognostic factors for persistent SNHL.
Transient and persistent SNHL occurred after radiotherapy, more commonly affecting high frequency. A low dose of preirradiation cisplatin did not increase the risk. A dose fractionation effect of radiotherapy was not confirmed in this study.
研究鼻咽癌（NPC）初次治疗后感音神经性听力损失（SNHL）的模式，并评估顺铂、放疗剂量及分割方式的影响。
分析了132例患者、227只耳及1100份听力图报告。放疗剂量范围为59.5至76.5 Gy。52例患者接受了放疗前顺铂治疗，总剂量为100 - 185 mg/m²。将放疗后0.5 kHz、1 kHz、2 kHz和4 kHz处的系列骨导阈值与各频率的治疗前阈值进行比较。至少增加15 dB被认为有意义，并进一步分为短暂性或持续性SNHL。进行单因素和多因素分析以确定持续性SNHL的预测因素。
中位随访30个月时，24.2%的耳发生了持续性SNHL。高频比低频更易受影响，分别为22%和5.3%。男性比女性更易受影响，分别为29.4%和15.5%，p = 0.0132。持续性SNHL的发生率随年龄增加而升高，年龄小于30岁、30 - 50岁和大于50岁的患者受影响的比例分别为0、17.2%和37.4%，p = 0.0001。放疗后浆液性中耳炎（SOM）患者的发生率较高，为46.9%。顺铂化疗、放疗剂量或分割方式无显著影响。多因素分析证实年龄、性别和放疗后SOM是持续性SNHL的重要预后因素。
放疗后出现短暂性和持续性SNHL，更常见于高频。低剂量放疗前顺铂未增加风险。本研究未证实放疗的剂量分割效应。
