鼻咽癌调强放疗联合含铂方案化疗后感音神经性听力损失及相关临床因素分析  

Clinical Analysis of Sensorineural Hearing Loss After Combined Intensity Modulated Radiation Therapy and Cisplatinbased Chemotherapy in Long-term Survivors with Nasopharyngeal Carcinoma and Its Associated Clinical Factors

作　　者：王谨[1] 李丽[1] 黄邵敏[2] 陈雪林[2] 陈媛媛[1] 赵充[2] 陈明[1] 

机构地区：[1]浙江省肿瘤医院,浙江省放射肿瘤学重点实验室,浙江杭州310022 [2]中山大学肿瘤防治中心,广东广州510060

出　　处：《肿瘤学杂志》2015年第3期171-174,共4页Journal of Chinese Oncology

基　　金：广东省医学科研基金(A2011196)

摘　　要：[目的]初步探讨鼻咽癌调强放射治疗（IMRT）联合含铂方案化疗后长期生存患者感音神经性听力损伤（SNHL）的发生率和影响因素。[方法]收集接受IMRT联合含铂方案化疗,至今无复发无转移的鼻咽癌患者53例,检测患者听力状态,分析临床因素与低频SNHL之间的相关性。[结果]53例患者,中位随访期为60个月（28-84个月）。共计106支耳接受听力检测。低频（0.5k Hz、1k Hz、2k Hz）SNHL发生率为14.2%,高频（4k Hz）SNHL发生率为44.3%。其中,初治时年龄超过50岁、UICC（2002分期）T4分期、接受累积顺铂化疗剂量超过200mg/m^2,及随访期间伴分泌性中耳炎者更易发生（P值分别为0.031、0.044、0.031、0.015）。多因素分析显示年龄、累积顺铂化疗剂量为低频SNHL的影响因素（P值分别是0.024、0.028,）,伴发分泌性中耳炎者低频SNHL发生风险也有可能增加（P=0.063）。[结论]对IMRT联合含铂化疗后的鼻咽癌患者,年龄、累积顺铂化疗剂量、伴分泌性中耳炎可影响SNHL的发生率,临床需引起注意。[Purpose ] To investigate the incidence of sensorineural hearing loss（SNHL） after treatment with combined intensity-modulated radiation therapy（IMRT） and cisplatin-based chemotherapy in nasopharyngeal carcinoma （NPC） patients,and its relevant clinical factors were analyzed. [Methods] Fifty-three NPC patients without recurrence and metastasis after being treated with IMRT were analyzed. Pure tone audiometry was performed. Correlation of SNHL at low frequencies（pure tone average,0.5-2kHz） with a series of factors was analyzed. [Results] The median follow-up time was 60 months（ranged from 28 months to 84 months）. Among 106 ears, 14.2% had low frequencies SNHL and 44.3% high frequency（4kHz） SNHL. The incidence of low frequencies SNHL was greater in patients with age〉50 years old, stage T4, cumulative cisplatin dose （CCD）〉 200mg/m^2,and secretory otitis media（SOM）（P=0.031,0.044,0.031,0.015,respectively）. Multivariate analysis indicated that age and CCD were the influencing factors of SNHL （P=0.024 and 0.028）,and SOM（P=0.063） might be the factor associated with SNHL. [Conclusion] For NPC patients treated with IMRT and cisplatin chemotherapy, age, CCD, and SOM might influence on the occurrence of treatment-related SNHL.

关 键 词：鼻咽肿瘤 调强放疗 药物疗法 听力损伤 顺铂 

分 类 号：R739.63[医药卫生—肿瘤]