Strahlentherapie und Onkologie

, Volume 187, Issue 6, pp 350–356 | Cite as

Prospective study on the dose distribution to the acoustic structures during postoperative 3D conformal radiotherapy for parotid tumors

Dosimetric and audiometric aspects
  • Barbara A. Jereczek-Fossa
  • Elena Rondi
  • Andrzej Zarowski
  • Alberto D’Onofrio
  • Daniela Alterio
  • Mario Ciocca
  • Livia Corinna Bianchi
  • Marco Krengli
  • Luca Calabrese
  • Mohssen Ansarin
  • Gioacchino Giugliano
  • Roberto Orecchia
Original Article

Background and Purpose:

To analyze dose distribution in the hearing organ and to evaluate the dose effect on the hearing thresholds in patients treated with post-parotidectomy 3-dimensional conformal radiotherapy (3D-CRT).

Methods and Materials:

A total of 17 patients received post-parotidectomy 3D-CRT (median dose: 63 Gy). The audiometric evaluation comprised pure tone audiometry and tympanometry performed before radiotherapy (RT) and 3, 6, and 24 months after RT. The ear structures were delineated on planning computer tomography scans. Mean and maximum doses were calculated and dose–volume histograms were plotted.


Before RT, the median baseline audiometric thresholds were normal. At 3 months post-RT, 3 patients were diagnosed as having middle ear underpressure and/or effusion that resolved completely by 6 months. During 2-year follow-up, none of the ears showed perceptive hearing loss at speech frequencies. The mean doses at ipsilateral external auditory canal, mastoids cells, tympanic case, Eustachian tube, semicircular canals, and cochlea were 44.8 Gy, 39.0 Gy, 30.9 Gy, 33.0 Gy, 19.6 Gy, and 19.2 Gy, respectively. The doses to the contralateral ear were negligible, except for the Eustachian tube (up to 28.2 Gy).


Post-parotidectomy 3D-CRT is associated with relatively low doses to the ear and the surrounding structures. Post-RT audiometry did not show any permanent (neither conductive nor perceptive) hearing impairment. Only in 3 patients were there signs of transient unilateral dysfunction of the Eustachian tube observed during the first few months after RT. Longer follow-up and larger patient series are warranted to confirm these preliminary findings.

Key Words

Parotid tumors Ear Cochlea Radiotherapy Dosimetry Dose–volume histograms 

Prospektive Studie zur Dosisverteilung im Hörorgan bei postoperativer 3D konformaler Radiotherapie von Parotistumoren. Dosimetrische und audiometrische Aspekte

Hintergrund und Ziel:

Dosisverteilungsanalyse im Hörorgan für Patienten mit 3-dimensionaler konformaler Radiotherapie (3D-CRT) nach Parotidektomie.

Patienten und Methoden:

17 Patienten erhielten eine 3D-CRT nach radikaler Parotidektomie (mittlere Dosis: 63 Gy). Die audiometrische Evaluierung umfasste Tonaudiometrie und Tympanometrie vor, 3, 6 und 24 Monate nach der Radiotherapie. Die Ohrstrukturen wurden im Planungscomputertomogramm konturiert. Die mittleren und maximalen Gesamtstrahlendosen wurden berechnet und die Dosis-Volumen-Histogramme ausgewertet.


Vor Radiotherapie waren die medianen audiometrischen Ausgangsgrenzwerte normal. 3 Monate nach der RT zeigten sich bei 3 Patienten Unterdruck im Mittelohr und/oder Effusion, die nach 6 Monaten vollständig verschwanden. Während des 2-jährigen Follow-up zeigte keines der Ohren perzeptive Hörverluste bei Sprachfrequenzen. Die mittleren Dosen im äußeren ipsilateralen Gehörgang, in Mastoidzellen, im Trommelfell, in der Eustachischen Röhre, in Bogengängen und Cochlea waren 44,8 Gy, 39,0 Gy, 30,9 Gy, 33,0 Gy, 19,6 Gy und 19,2 Gy. Die Dosen im kontralateralen Ohr waren vernachlässigbar, abgesehen von der Eustachischen Röhre (bis zu 28,2 Gy).


3D-CRT nach Parotidektomie ist mit relativ geringen Dosen im Hörorgan verbunden. Audiometrie nach der RT zeigte keine Hörschäden an. Längere Folgestudien und größere Patientenserien sind gerechtfertigt, um diese vorläufigen Ergebnisse zu bestätigen.


Parotistumoren Ohr Cochlea Radiotherapie Dosimetrie Dosis-Volumen-Histogramme 


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Copyright information

© Urban & Vogel, Muenchen 2011

Authors and Affiliations

  • Barbara A. Jereczek-Fossa
    • 1
    • 5
    • 8
  • Elena Rondi
    • 2
  • Andrzej Zarowski
    • 6
  • Alberto D’Onofrio
    • 4
  • Daniela Alterio
    • 1
  • Mario Ciocca
    • 2
  • Livia Corinna Bianchi
    • 1
  • Marco Krengli
    • 7
  • Luca Calabrese
    • 3
  • Mohssen Ansarin
    • 3
  • Gioacchino Giugliano
    • 3
  • Roberto Orecchia
    • 1
    • 5
  1. 1.Division of RadiotherapyEuropean Institute of OncologyMilanItaly
  2. 2.Division of Medical PhysicsEuropean Institute of OncologyMilanItaly
  3. 3.Division of Head and Neck SurgeryEuropean Institute of OncologyMilanItaly
  4. 4.Department of Experimental OncologyEuropean Institute of OncologyMilanItaly
  5. 5.Faculty of Medicine of the University of MilanMilanItaly
  6. 6.University Department of Otolaryngology, Head and Neck SurgerySt. Augustinus HospitalAntwerpBelgium
  7. 7.Radiotherapy DepartmentUniversity of Piemonte OrientaleNovaraItaly
  8. 8.Division of RadiotherapyEuropean Institute of OncologyMilanItaly

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