Radiation dose to otologic structures during head and neck cancer radiation therapy.
BACKGROUND
Otologic structures are often contained within head and neck cancer radiation treatment ports. The dosimetry to otologic structures has not been routinely analyzed and radiation treatment planning does not currently attempt to specifically avoid the inner ear structures when dosimetry is calculated. Recent studies demonstrate that up to 30% of patients experience sensorineural hearing loss on multimodality therapy with cisplatin and radiation.


METHODS
In the current case series, radiation dosimetry to otologic structures was calculated from computed tomogram treatment plans on patients. Fifteen nasopharyngeal, oral cavity, oropharyngeal, and hypopharyngeal cancer patients were analyzed.


RESULTS
Between 8% and 102% of the total dose is delivered to the petrous bone/cochlea, with 4 of 15 patients getting more than 50% of the dose to at least one cochlea The mastoid air cells received between 3% and 75% of the total dose, with higher doses being delivered to patients with bulky high neck metastases or nasopharyngeal tumors. The eustachian tubes received between 20% and 102% of the total dose, with 10 of 15 patients receiving more than 50% of the dose to this anatomic site.


CONCLUSIONS
We conclude that the cochlea and eustachian tubes receive significant radiation during treatment, particularly in nasopharyngeal cancer patients. Careful design of radiation treatment ports may allow for the reduction of radiation to hearing structures.
Ondrey
F G
FG
Head and Neck Surgery Branch of the National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA.
Greig
J R
JR
Herscher
L
L
D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D003051:Cochlea / Q000528:radiation effects*; D005064:Eustachian Tube / Q000528:radiation effects*; D006319:Hearing Loss, Sensorineural / Q000209:etiology*; D006801:Humans; D008416:Mastoid / Q000528:radiation effects; D009062:Mouth Neoplasms / Q000532:radiotherapy*; D010579:Petrous Bone / Q000528:radiation effects; D010610:Pharyngeal Neoplasms / Q000532:radiotherapy*; D011874:Radiometry; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted