Auditory Preservation in Nasopharyngeal Carcinoma: Comparison of Proton and Photon Radiotherapy

Kuang‐Hsu Lien; Chien‐Yu Lin; Po‐Yuan Chen; Ji Hyun Chang; Tai‐Yu Chen; Sheng‐Ping Hung; Ching‐Hsin Lee; Wing‐Keen Yap; Cheng‐En Hsieh; Cheng‐Lung Hsu; Chi‐Yin Lee; Kai‐Ping Chang

doi:10.1002/ohn.70113

journal article Open Access Jan 08, 2026

Auditory Preservation in Nasopharyngeal Carcinoma: Comparison of Proton and Photon Radiotherapy

Kuang‐Hsu Lien

Chien‐Yu Lin Po‐Yuan Chen Ji Hyun Chang

Tai‐Yu Chen Sheng‐Ping Hung Ching‐Hsin Lee Wing‐Keen Yap Cheng‐En Hsieh Cheng‐Lung Hsu Chi‐Yin Lee Kai‐Ping Chang

Otolaryngology–Head and Neck Surgery Vol. 174 No. 2 pp. 450-457 · Wiley

View at Publisher Save 10.1002/ohn.70113

Abstract

Abstract

Objective
To compare cochlear dose and hearing outcomes between intensity‐modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) in patients with nasopharyngeal carcinoma (NPC).

Study Design
Prospective matched cohorts.

Setting
Tertiary academic center.

Methods
A total of 180 newly diagnosed, treatment‐naive NPC patients receiving definitive radiotherapy between 2023 and 2025 were enrolled. Patients were 1:1 matched by sex, age, and disease stage, and assigned to IMPT (n = 90) or VMAT (n = 90). Mean cochlear dose was recorded. Audiological evaluations, including pure‐tone audiometry (PTA), air‐bone gap, and word recognition score, were performed before and after treatment.

Results

IMPT delivered significantly lower mean doses to the ipsilateral (47.51 vs 56.82 Gy,
P
< .001; 95% CI: –14.27 to –4.35) and contralateral cochlea (30.79 vs 45.71 Gy,
P
< .001; 95% CI: –18.93 to –10.91). Based on each patient's most recent audiometric assessment (median follow‐up, 12.1 months; range, 7.5‐19.5 months), IMPT demonstrated better average PTA thresholds than VMAT (33.72 vs 42.00 dB;
P
= .016; 95% CI, –14.91 to –1.65), superior high‐frequency hearing at 2 to 8 kHz (37.94 vs 53.82 dB;
P
< .001; 95% CI, –23.69 to –8.07), lower air‐bone gap (5.67 vs 10.62 dB;
P
< .001; 95% CI, –6.80 to –3.10), and higher word recognition scores (96.67% vs 94.00%;
P
= .039; 95% CI, 0.14‐5.20), with less bone conduction loss at 1 to 4 kHz.

Conclusion
IMPT reduces cochlear dose compared to VMAT, resulting in better hearing preservation and suggesting its potential to minimize ototoxicity in NPC patients.

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References

Details

Published: Jan 08, 2026
Vol/Issue: 174(2)
Pages: 450-457
License: View

Authors

K

Kuang‐Hsu Lien

Department of Otolaryngology–Head & Neck Surgery Linkou Chang Gung Memorial Hospital Taoyuan City 333423 Guishan District Taiwan; School of Traditional Chinese Medicine, College of Medicine Chang Gung University Taoyuan 333323 Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine Chang Gung University Taoyuan 333323 Taiwan

C

Chien‐Yu Lin

Department of Radiation Oncology, Proton and Radiation Therapy Center Linkou Chang Gung Memorial Hospital Taoyuan City 333423 Guishan District Taiwan; Radiation Research Core Laboratory Chang Gung Memorial Hospital at Linkou Taoyuan City 333423 Guishan District Taiwan; College of Medicine Chang Gung University Taoyuan 333323 Taiwan

P

Po‐Yuan Chen