Dose-volume factors associated with ear disorders following intensity modulated radiotherapy in nasopharyngeal carcinoma

Ji-Jin Yao, Guan-Qun Zhou, Li Lin, Wang-Jian Zhang, Ying-Lin Peng, Lei Chen, Ling-Long Tang, Yan-Ping Mao, Jun Ma, Ying Sun, Ji-Jin Yao, Guan-Qun Zhou, Li Lin, Wang-Jian Zhang, Ying-Lin Peng, Lei Chen, Ling-Long Tang, Yan-Ping Mao, Jun Ma, Ying Sun

Abstract

This study is to identify significant dosimetric parameters for ear disorders in nasopharyngeal carcinoma (NPC) patients treated with intensity modulated therapy only. Ninety-seven patients with NPC were retrospectively reviewed. Organs at risk (OARs) in the auditory apparatus were contoured. Dose-volume histogram parameters were generated for the Eustachian tube (ET), tympanic cavity (TC), mastoid air cells, vestibular apparatus, cochlea and internal auditory canal (IAC). Ear disorders were rated 0 (none), 1 (mild) or 2 (severe) by a clinician blinded to radiation doses; Grade 2 ear disorders was the study end-point. Multivariate analysis revealed ET.D30 (dose to 30% of ET volume) >52.75 Gy and M.D0.5CC (dose to 0.5 ml of mastoid volume) >41.04 Gy (OR = 3.77, P = 0.012 and OR = 1.27, P = 0.033, respectively) were associated with Grade 2 ear disorders. Our results demonstrated that post-irradiation ear disorders remain a common late toxicity in NPC after IMRT. ET.D30 and M.D0.5CC should be considered during IMRT treatment plan optimization, review and approval.

Figures

Figure 1. CT imaging of the anatomy…
Figure 1. CT imaging of the anatomy of the Eustachian tube (ET), tympanic cavity (TC), mastoid air cells (Mastoid), vestibular apparatus (VS), cochlea (C), and internal auditory canal (IAC).
Figure 2
Figure 2
(A) Receiver operating characteristic (ROC) curve analysis for the ET.D30 (dose to 30% of the Eustachian tube volume). The cutoff point for the ET.D30 was determined as 52.75 Gy for patients with NPC treated with IMRT. (B) Receiver operating characteristic (ROC) curve for the M.D0.5CC (dose to 0.5 ml of the mastoid volume). The cutoff point for the M.D0.5CC was determined as 41.04 Gy for patients with NPC treated with IMRT.

References

    1. Jemal A., Bray F., Center M. M., Ferlay J., Ward E. & Forman D. Global cancer statistics. CA Cancer J Clin 61, 69–90, 10.3322/caac.20107 (2011).
    1. Hsu M. M., Young Y. H. & Lin K. L. Eustachian tube function of patients with nasopharyngeal carcinoma. Ann Otol Rhinol Laryngol 104, 453–455 (1995).
    1. Young Y. H. & Hsieh T. Eustachian tube dysfunction in patients with nasopharyngeal carcinoma, pre-and post-irradiation. Eur Arch Otorhinolaryngol 249, 206–208 (1992).
    1. Bhandare N., Antonelli P. J., Morris C. G., Malayapa R. S. & Mendenhall W. M. Ototoxicity after radiotherapy for head and neck tumors. Int J Radiat Oncol Biol Phys 67, 469–479 (2007).
    1. Tang N. L., Choy A. T., John D. G. & Hasselt C. A. The otological status of patients with nasopharyngeal carcinoma after megavoltage radiotherapy. J Laryngol Otol 106, 1055–1058 (1992).
    1. Low W. K. & Fong K. W. Long-term post-irradiation middle ear effusion in nasopharyngeal carcinoma. Auris Nasus Larynx 25, 319–321 (1998).
    1. Kew J. et al. Middle ear effusions after radiotherapy: correlation with pre-radiotherapy nasopharyngeal tumor patterns. Am J Otol 21, 782–785 (2000).
    1. Sun Y. et al. Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. Radiother Oncol 110, 390–397, 10.1016/j.radonc.2013.10.035 (2014).
    1. Pan C. C., Eisbruch A., Lee J. S., Snorrason R. M., Ten Haken R. K. & Kileny P. R. Prospective study of inner ear radiation dose and hearing loss in head-and-neck cancer patients. Int J Radiat Oncol Biol Phys 61, 1393–1402 (2005).
    1. Herrmann F., Dörr W., Müller R. & Herrmann T. A prospective study on radiation-induced changes in hearing function. Int J Radiat Oncol Biol Phys 65, 1338–1344 (2006).
    1. Walker G. V. et al. Radiation-induced middle ear and mastoid opacification in skull base tumors treated with radiotherapy. Int J Radiat Oncol Biol Phys 81, 819–823, 10.1016/j.ijrobp.2010.11.047 (2011).
    1. Hitchcock Y. J., Tward J. D., Szabo A., Bentz B. G. & Shrieve D. C. Relative contributions of radiation and cisplatin-based chemotherapy to sensorineural hearing loss in head-and-neck cancer patients. Int J Radiat Oncol Biol Phys 73, 779–788, 10.1016/j.ijrobp.2008.05.040 (2009).
    1. Edge S. B., Fritz A. G., Byrd D. R., Greene F. L., Compton C. C. & Trotti A. Pharynx (Including Base of Tongue, Soft Palate, and Uvula). AJCC cancer staging manual, 41–56 (2010).
    1. Nishimura R. et al. MR evaluation of radiation otomastoiditis. Int J Radiat Oncol Biol Phys 39, 155–160 (1997).
    1. Bhandare N., Antonelli P. J., Morris C. G., Malayapa R. S. & Mendenhall W. M. Ototoxicity after radiotherapy for head and neck tumors. Int J Radiat Oncol Biol Phys 67, 469–479 (2007).
    1. Zeng L. et al. Late toxicities after intensity-modulated radiotherapy for nasopharyngeal carcinoma: patient and treatment-related risk factors. Br J Cancer 110, 49–54, 10.1038/bjc.2013.720 (2014).
    1. Liang K. L., Su M. C., Twu C. W., Jiang R. S., Lin J. C. & Shiao J. Y. Long-term result of management of otitis media with effusion in patients with post-irradiated nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 268, 213–217, 10.1007/s00405-010-1381-1 (2011).
    1. Kujawski O. B. & Poe D. S. Laser eustachian tuboplasty. Otol Neurotol 25, 1–8 (2004).
    1. Xu Y. D., Ou Y. K., Zheng Y. Q., Chen Y. & Ji S. F. The treatment for postirradiation otitis media with effusion: a study of three methods. Laryngoscope 118, 2040–2043, 10.1097/MLG.0b013e31818208 d6 (2008).
    1. Grau C., Moller K., Overgaard M., Overgaard J. & Elbrond O. Sensori-neural hearing loss in patients treated with irradiation for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 21, 723–728 (1991).
    1. Kwong D. L. et al. Sensorineural hearing loss in patients treated for nasopharyngeal carcinoma: A prospective study of the effect of radiation and cisplatin. Int J Radiat Oncol Biol Phys 36, 281–9 (1996).
    1. Hsin C. H., Chen T. H., Liang K. L., Tseng H. C. & Liu W. S. Postirradiation otitis media with effusion in nasopharyngeal carcinoma patients treated by intensity-modulated radiotherapy. Laryngoscope 123, 2148–53, 10.1002/lary.23215 (2013).
    1. Wang S. Z. et al. A study of middle ear function in the treatment of nasopharyngeal carcinoma with IMRT technique. Radiother Oncol 93, 530–533, 10.1016/j.radonc.2009.09.013 (2009).

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