调强放疗对鼻咽癌听力影响的多因素分析

发布时间：2018-07-21 19:39

【摘要】：目的:分析鼻咽癌调强(IMRT)放疗后听力下降的诸因素,明确耳结构的耐受剂量,为放疗计划的制定提供参考。 方法:选取2005年1月至2009年12月在河北医科大学第四医院放疗科接受全程调强放疗,且有明确病理诊断的的鼻咽癌初治患者75例。从治疗计划上勾画耳结构,从治疗计划上读出对应的体积剂量、平均剂量、最大剂量。用SPSS13.0软件和χ~2检验进行统计分析,P0.05为有统计学意义。 结果: T分期( P = 0.023)、放疗前中耳炎史( P = 0.023)及鼻咽肿瘤累及侧壁等( P = 0.033)与放疗后听力下降相关。放疗剂量对听力的影响:(1)中耳:中耳平均剂量45 Gy(P=0.035),V3075% (P=0.043),V5065%(P=0.048)者,放疗后发生听力下降者多;中耳平均值50Gy的患者放疗后发生Ⅱ级听力下降者明显多于≤50Gy,有显著性差异(P=0.019)。(2)外耳:最大剂量45Gy(P=0.036)放疗后发生听力下降者多;(3)且中耳平均值≤50Gy(P=0.019),外耳最大值60Gy(P=0.021),V1080%(P=0.003),V2060%(P=0.003)的患者发生Ⅱ级听力下降者多。 结论:耳结构剂量较为合适范围为:使中耳平均值≤45Gy,中耳V30≤75%,中耳V50≤65%,外耳最大值≤45Gy。鼻咽癌放疗避免发生Ⅱ级听力下降的耳部剂量较为合适范围为:中耳平均值≤50Gy,外耳V10≤80%,外耳V20≤60%,外耳最大值≤60Gy,对于放疗前有中耳炎史的鼻咽癌病人更应注意剂量限制。
[Abstract]:Objective: to analyze the factors of hearing loss after intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC), to determine the tolerance dose of ear structure, and to provide reference for the formulation of radiotherapy plan. Methods: from January 2005 to December 2009, 75 patients with nasopharyngeal carcinoma (NPC) who received full intensity modulated radiotherapy (IMRT) in the Department of radiotherapy, fourth Hospital of Hebei Medical University and had definite pathological diagnosis were selected. Outline the ear structure from the treatment plan and read the corresponding volume dose, average dose, maximum dose from the treatment plan. SPSS 13.0 software and 蠂 2 test were used for statistical analysis. Results: t stage (P = 0.023), history of otitis media before radiotherapy (P = 0.023) and lateral wall involvement of nasopharyngeal tumor (P = 0.033) were correlated with hearing loss after radiotherapy. The effects of radiotherapy dose on hearing were as follows: (1) in middle ear, the average dose of 45 Gy (P0. 035) V 3075% (P0. 043) and V 50. 65% (P0. 048) in middle ear were more than those with hearing loss after radiotherapy. There was a significant difference (P0. 019). (2) in the patients with grade II hearing loss after radiotherapy (P0. 019). (2): most of the patients suffered from hearing loss after radiotherapy at the maximum dose of 45 Gy (P0. 036). (3) the mean value of the middle ear was 鈮，

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