CAJ | 학술논문

目的分析鼻咽癌患者调强放疗后感音神经性听力下降(SNHL)的影响因素.方法比较2012-2013年间接受单纯放疗和同期放化疗的29例鼻咽癌患者声导抗测听、纯音听阈测定及耳蜗放射剂量,所有患者均接受调强放疗.采用前瞻性分析方法分析耳蜗放射剂量对鼻咽癌患者SNHL的影响,同时了解放疗后时间、化疗、T分期、年龄等因素对结果的影响.结果 58只耳中6只(10％)发生了低频SNHL,17只(29％)发生高频SNHL.放疗后发生感音神经性耳聋患者和未发生听力下降患者耳蜗剂量不同(左耳46.1 Gy∶35.5 Gy,P=0.006；右耳45.0 Gy∶35.8 Gy,P=0.009).当耳蜗平均剂量限制到44 Gy以下时只有15％ (6/38)耳发生SNHL.颅底骨质破坏对听力有影响(P =0.047).结论耳蜗的平均剂量和颅底骨质的侵犯是鼻咽癌患者放疗后SNHL的重要影响因素.建议耳蜗的平均剂量限制在44 Gy是合理的.
목적 분석비인암환자조강방료후감음신경성은력하강(SNHL)적영향인소.방법 비교2012-2013년간접수단순방료화동기방화료적29례비인암환자성도항측은、순음은역측정급이와방사제량,소유환자균접수조강방료.채용전첨성분석방법분석이와방사제량대비인암환자SNHL적영향,동시료해방료후시간、화료、T분기、년령등인소대결과적영향.결과 58지이중6지(10％)발생료저빈SNHL,17지(29％)발생고빈SNHL.방료후발생감음신경성이롱환자화미발생은력하강환자이와제량불동(좌이46.1 Gy∶35.5 Gy,P=0.006；우이45.0 Gy∶35.8 Gy,P=0.009).당이와평균제량한제도44 Gy이하시지유15％ (6/38)이발생SNHL.로저골질파배대은력유영향(P =0.047).결론 이와적평균제량화로저골질적침범시비인암환자방료후SNHL적중요영향인소.건의이와적평균제량한제재44 Gy시합리적.
Objective To investigate the risk factors for sensorineural hearing loss (SNHL) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).Methods From January 2012 to January 2013,29 patients with histopathologically confirmed NPC who received radiotherapy alone or concurrent chemoradiotherapy were included in this study.All patients underwent hearing tests,including pure tone audiometry and acoustic immittance measurement,before and after the IMRT.The cochlear doses for each ear were also collected for analysis.A prospective analysis was performed to investigate the relationship between cochlear dose and SNHL in patients with NPC,and the effects of other factors,including time after radiotherapy,chemotherapy,T stage,and age,were also analyzed.Results Of the 58 ears studied,6(10％) had low-frequency SNHL,and 17 (29％) had highfrequency SNHL.There were significant differences in mean cochlear doses between the patients who developed SNHL after radiotherapy and those who did not (left ears:46.1 Gy vs.35.5 Gy,P =0.006;right ears:45.0 Gy vs.35.8 Gy,P =0.009).When the mean cochlear dose was less than 44 Gy,only 15％ (6/38) of ears had high-frequency SNHL.The invasion of skull base bone was also a significant risk factor for SNHL(P =0.047),but age,chemotherapy,and time after IMRT were not significant risk factors.Conclusions The mean cochlear dose and invasion of skull base bone are significant risk factors for SNHL in patients with NPC after radiotherapy.It is recommended that the mean cochlear dose should be limited to 44 Gy to minimize the incidence of SNHL after IMRT.