Early neuro-otologic effects of three-dimensional irradiation in children with primary brain tumors

被引:77
作者
Merchant, TE
Gould, CJ
Xiong, XP
Robbins, N
Zhu, JH
Pritchard, DL
Khan, R
Heideman, RL
Krasin, MJ
Kun, LE
机构
[1] St Jude Childrens Res Hosp, Dept Radiat Oncol, Memphis, TN 38105 USA
[2] St Jude Childrens Res Hosp, Dept Biostat, Memphis, TN 38105 USA
[3] St Jude Childrens Res Hosp, Dept Rehabil Serv, Memphis, TN 38105 USA
[4] St Jude Childrens Res Hosp, Dept Neurooncol, Memphis, TN 38105 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2004年 / 58卷 / 04期
关键词
hearing; radiotherapy; chemotherapy; ependymoma; craniopharyngioma;
D O I
10.1016/j.ijrobp.2003.07.008
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Central nervous system (CNS) irradiation can cause sensorineural hearing loss. The relationship between the dose to the cochlea and the development of hearing loss is unknown. Conformal radiation therapy (CRT) techniques facilitate accurate cochlear dosimetry. We modeled hearing threshold levels (HTL) after CRT in children with localized primary brain tumors (ependymoma, low- or high-grade astrocytoma, craniopharyngioma, or CNS germinoma) by using cochlear dose and clinical variables. Patients and Methods: We evaluated 72 children (median age, 9.5 years) with audiograms before and every 6 months after CRT (median follow-up, 16.6 months; range, 4.3-42.6 months). We used a mixed-effects model to predict change in hearing for each ear as a function of time, cochlear dose, and clinical variables. Results: Hearing was affected the greatest in patients with CSF shunts and pre-CRT ototoxic chemotherapy, enhanced by cochlear dose, and was more prominent on the right side. Hearing impairment after CRT alone occurred at low and intermediate frequencies in patients with shunts and supratentorial tumors when the cochlear dose exceeded 32 Gy. Patients with shunts and central supratentorial tumors developed intermediate-frequency hearing loss after CRT alone regardless of dose. Conclusions: Hearing loss during the first 4 years after CRT alone is uncommon, although patients with shunts and supratentorial tumors appear to be at increased risk for low- and intermediate-frequency effects. CSF shunting and increased cochlear dose enhance the effect of ototoxic chemotherapy. If possible, the average cochlear dose should be <32 Gy over a 6-week course of treatment until more specific dose data become available. (C) 2004 Elsevier Inc.
引用
收藏
页码:1194 / 1207
页数:14
相关论文
共 46 条
[1]  
[Anonymous], 1993, 50 ICRU
[2]   A PROSPECTIVE LONGITUDINAL-STUDY ON RADIATION-INDUCED HEARING-LOSS [J].
ANTEUNIS, LJC ;
WANDERS, SL ;
HENDRIKS, JJT ;
LANGENDIJK, JA ;
MANNI, JJ ;
DEJONG, JMA .
AMERICAN JOURNAL OF SURGERY, 1994, 168 (05) :408-411
[3]  
BOHNE BA, 1985, LARYNGOSCOPE, V95, P818
[4]   IONIZING RADIATION AND EAR [J].
BORSANYI, SJ ;
BLANCHARD, CL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1962, 181 (11) :958-&
[5]   UNILATERAL HEARING-LOSS IN CHILDREN [J].
BROOKHOUSER, PE ;
WORTHINGTON, DW ;
KELLY, WJ .
LARYNGOSCOPE, 1991, 101 (12) :1264-1272
[6]  
Dias A, 1966, J Laryngol Otol, V80, P276, DOI 10.1017/S0022215100065233
[7]   THE NONINVASIVE ASSESSMENT OF INTRACOCHLEAR PRESSURE .3. CASE-REPORTS ON PATIENTS SUFFERING FROM INTRACOCHLEAR HYPERTENSION AND HYPOTENSION [J].
ERNST, A ;
BOHNDORF, M ;
LENARZ, T .
LARYNGO-RHINO-OTOLOGIE, 1995, 74 (03) :150-154
[8]   ASSESSMENT OF PERMANENT HEARING IMPAIRMENT FOLLOWING RADICAL MEGAVOLTAGE RADIOTHERAPY [J].
EVANS, RA ;
LIU, KC ;
AZHAR, T ;
SYMONDS, RP .
JOURNAL OF LARYNGOLOGY AND OTOLOGY, 1988, 102 (07) :588-589
[9]  
GAMBLE JE, 1968, ARCH OTOLARYNGOL, V88, P156
[10]   SENSORINEURAL HEARING-LOSS IN PATIENTS TREATED WITH IRRADIATION FOR NASOPHARYNGEAL CARCINOMA [J].
GRAU, C ;
MOLLER, K ;
OVERGAARD, M ;
OVERGAARD, J ;
ELBROND, O .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1991, 21 (03) :723-728