Intensity-modulated radiation therapy for pediatric medulloblastoma: Early report on the reduction of ototoxicity
Intensity-modulated radiation therapy for pediatric medulloblastoma: Early report on the reduction of ototoxicity
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DOI：
10.1016/s0360-3016(01)02641-4
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发表时间：
2002-03-01
影响因子：
7
通讯作者：
Woo, SY
中科院分区：
文献类型：
--
作者：
Huang, E;Strother, DR;Woo, SY
目的：顺铂联合放射治疗髓母细胞瘤具有明显的耳毒性，影响儿童的认知功能和生活质量。我们的目的是确定新的适形调强放射治疗(IMRT)技术是否可以通过减少对耳蜗和第八脑神经(听觉器官)的照射剂量来降低听力损失的发生率。患者和方法：26例儿童髓母细胞瘤患者被回顾性地分为常规放疗组(常规放疗组)和调强放疗组(调强放疗组)。对113例纯音测听图进行了回顾性评价，听力功能按儿科肿瘤学组的毒性标准进行0~4级评分。结果：与常规放射治疗相比，调强适形放射治疗的受照剂量占听器受照剂量的68%(平均剂量：36.7Gyvs.54.2Gy.)。测听评估显示，尽管顺铂的累积剂量较高，但调强放疗组在每个频率的平均分贝听阈都低于常规放疗组。调强放射治疗组的总体耳毒性发生率较低。调强放射治疗组有13%的人听力损失为3级或4级，而常规放疗组的听力损失为%(p<；0.014)。结论：调强放疗的适形技术向听器提供的辐射剂量要低得多，同时仍能提供所需的全量靶区。我们的发现表明，尽管顺铂的剂量更大，尽管在顺铂治疗之前进行放射治疗，但调强放射治疗可以达到较低的听力损失比率。(C)2002年爱思唯尔科学公司。
Purpose: The combination of cisplatin chemotherapy and radiation therapy for the treatment of medulloblastoma has been shown to cause significant ototoxicity, impairing a child's cognitive function and quality of life. Our purpose is to determine whether the new conformal technique of intensity-modulated radiation therapy (IMRT) can achieve lower rates of hearing loss by decreasing the radiation dose delivered to the cochlea and eighth cranial nerve (auditory apparatus).Patients and Methods: Twenty-six pediatric patients treated for medulloblastoma were retrospectively divided into two groups that received either conventional radiotherapy (Conventional-RT Group) or IMRT (IMRT Group). One hundred thirteen pure-tone audiograms were evaluated retrospectively, and hearing function was graded on a scale of 0 to 4 according to the Pediatric Oncology Group's toxicity criteria. Statistical analysis comparing the rates of ototoxicity was performed using Fisher's exact test with two-tailed analysis.Results: When compared to conventional radiotherapy, IMRT delivered 68% of the radiation dose to the auditory apparatus (mean dose: 36.7 vs. 54.2 Gy). Audiometric evaluation showed that mean decibel hearing thresholds of the IMRT Group were lower at every frequency compared to those of the Conventional-RT Group, despite having higher cumulative doses of cisplatin. The overall incidence of ototoxicity was lower in the IMRT Group. Thirteen percent of the IMRT Group had Grade 3 or 4 hearing loss, compared to 64% of the Conventional-RT Group (p < 0.014).Conclusion: The conformal technique of IMRT delivered much lower doses of radiation to the auditory apparatus, while still delivering full doses to the desired target volume. Our findings suggest that, despite higher doses of cisplatin, and despite radiotherapy before cisplatin therapy, treatment with IMRT can achieve a lower rate of hearing loss. (C) 2002 Elsevier Science Inc.