【摘要】：目的:分析鼻咽癌調(diào)強(qiáng)(IMRT)放療后聽(tīng)力下降的諸因素,明確耳結(jié)構(gòu)的耐受劑量,為放療計(jì)劃的制定提供參考。 方法:選取2005年1月至2009年12月在河北醫(yī)科大學(xué)第四醫(yī)院放療科接受全程調(diào)強(qiáng)放療,且有明確病理診斷的的鼻咽癌初治患者75例。從治療計(jì)劃上勾畫耳結(jié)構(gòu),從治療計(jì)劃上讀出對(duì)應(yīng)的體積劑量、平均劑量、最大劑量。用SPSS13.0軟件和χ~2檢驗(yàn)進(jìn)行統(tǒng)計(jì)分析,P0.05為有統(tǒng)計(jì)學(xué)意義。 結(jié)果: T分期( P = 0.023)、放療前中耳炎史( P = 0.023)及鼻咽腫瘤累及側(cè)壁等( P = 0.033)與放療后聽(tīng)力下降相關(guān)。放療劑量對(duì)聽(tīng)力的影響:(1)中耳:中耳平均劑量45 Gy(P=0.035),V3075% (P=0.043),V5065%(P=0.048)者,放療后發(fā)生聽(tīng)力下降者多;中耳平均值50Gy的患者放療后發(fā)生Ⅱ級(jí)聽(tīng)力下降者明顯多于≤50Gy,有顯著性差異(P=0.019)。(2)外耳:最大劑量45Gy(P=0.036)放療后發(fā)生聽(tīng)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)的患者發(fā)生Ⅱ級(jí)聽(tīng)力下降者多。 結(jié)論:耳結(jié)構(gòu)劑量較為合適范圍為:使中耳平均值≤45Gy,中耳V30≤75%,中耳V50≤65%,外耳最大值≤45Gy。鼻咽癌放療避免發(fā)生Ⅱ級(jí)聽(tīng)力下降的耳部劑量較為合適范圍為:中耳平均值≤50Gy,外耳V10≤80%,外耳V20≤60%,外耳最大值≤60Gy,對(duì)于放療前有中耳炎史的鼻咽癌病人更應(yīng)注意劑量限制。
[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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