J Clin Oncol:儿童放化疗后,听力损失的发生率和风险因素调查

2021-10-22 AlexYang MedSci原创

在许多儿童中枢神经系统和头颈部(H&N)肿瘤的治愈性治疗中,需要进行放疗(RT)、顺铂或卡铂治疗,但会产生不可逆转的耳毒性结果。

在许多儿童中枢神经系统和头颈部(H&N)肿瘤的治愈性治疗中,需要进行放疗(RT)、顺铂或卡铂治疗,但会产生不可逆转的耳毒性结果。这些治疗可能会导致高频听力损失(HL),并可能发展为低频损失,潜伏期为治疗后数年

近期,来自加拿大的研究人员在《J Clin Oncol》上发表文章,评估了放疗和化疗暴露患者中,听力损失的发生率和风险因素

研究人员评估了171名中枢神经系统或头颈部肿瘤患者的340只耳朵,他们均接受了放疗,同时进行化疗或不进行化疗。这些患者均进行了纵向听觉评估。使用了多变量加权有序逻辑回归评估了临床病理特征对HL的影响。

研究结果发现,平均耳蜗剂量(几率[OR]1.04/Gy,P<0.001),放疗后时间(RT;OR 1.21/年,P<0.001),顺铂剂量(OR 1.48/100 mg/m2,P<0.001)和卡铂剂量(OR 1.41/1000 mg/m2,P=0.002)与国际儿科肿瘤学会-波士顿HL分级的增加有关。研究人员没有发现RT和顺铂(交互项,P=0.53)或RT和卡铂(交互项,P=.85)存在协同作用。另外,如果平均耳蜗剂量>30Gy,高频HL(>4kHz)的累积发生率在RT后五年为50%或更高,且所有频率的HL发生率在RT五年后持续增加。

评估重度听力损失风险的列线图

综上所述,接受放疗和化疗的儿童的HL的发病率很高,且HL严重度与顺铂或卡铂剂量以及平均耳蜗剂量之间存在关系。因此,建议将平均耳蜗剂量≤30Gy来降低HL风险;对于接受铂类化疗的患者,可考虑采用较低的剂量(20-25Gy)来减轻HL负担

原始出处:

Dana Keilty , Mohammad Khandwala , Zhihui Amy Liu et al. Hearing Loss After Radiation and Chemotherapy for CNS and Head-and-Neck Tumors in Children. J Clin Oncol. Sep 2021

 

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    2021-11-24 minlingfeng
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    2021-10-24 ysjykql

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