Search

BackgroundBoth radiotherapy (RT) and cisplatin-based chemoradiotherapy (CRT) in patients with head and neck cancer may cause sensorineural hearing loss (SNHL). The purpose of this review was to provide more insight into SNHL because of CRT compared to RT.MethodsComprehensive search of Medline and Embase with the terms radiotherapy combined with ototoxicity, head and neck squamous cell carcinoma, and synonyms.ResultsOf the 2507 studies found, 21 were included in this study. Pooled analysis could not be committed because of heterogeneity. Incidence rates of SNHL after RT and CRT varied considerably, with percentages ranging from 0% to 43% and 17% to 88%, respectively. Factors that influenced the risk of SNHL were radiation dose to the cochlea, follow-up time, age, baseline hearing level, and cisplatin dose.ConclusionThe wide range of SNHL incidence rates makes it impossible to draw any conclusions on the severity of RT- and CRT-induced ototoxicity. To allow for future comparison of study outcomes, development of uniform criteria is of utmost importance. (c) 2014 Wiley Periodicals, Inc. Head Neck37: 281-292, 2015

Ototoxicity is a common adverse event after cisplatin treatment and radiotherapy to the head and neck area. Counseling patients about this adverse event is important. The thesis main objective is to improve our knowledge ototoxicity in patients with head and neck cancer. A systematic review showed that it is impossible to draw unambiguous conclusions about the incidence of (C)RT-induced ototoxicity, since different definitions of ototoxicity are used in the literature. Existing standards to score hearing impairment are available, but not consistently used. By developing a new grading system we facilitate a nuanced system, that may be used to assess the impact of hearing loss in specific situations in daily life. Furthermore, we developed a model to predict the treatment-induced hearing loss per individual. Based on pre-treatment hearing levels, radiation dose, and cisplatin dose, the model predicts the post-treatment hearing level at PTA 1-2-4 kHz. This model is a step towards improving counseling of patients. In a long-term follow-up study we found significant CRT-induced hearing loss at long-term. Patients treated with CRT intra-arterial showed significantly less hearing loss at both short-term and long-term post-treatment measurements compared to patients treated with CRT intravenous. Another follow-up study showed that patients treated with IMRT suffer from modest treatment-induced hearing loss, provided that the radiation dose to the cochlea is limited. In a study regarding hearing loss due to radiotherapy for head and neck rhabdomysarcoma in children, we concluded that 19% developed clinically relevant hearing loss at speech frequencies. Less hearing loss was seen after AMORE-based treatment compared to EBRT-based treatment.

Objectives/HypothesisThe purpose of this study was to determine whether concomitant chemoradiation (CCRT)-induced hearing loss is progressive over time or not.Study DesignLong-term (LT) follow-up study.MethodsBetween 1999 and 2004, 158 patients with head and neck cancer were treated with intravenous (IV) CCRT (n = 80) or intraarterial CCRT (n = 78). Audiometry was performed before, short-term (ST), and LT posttreatment. Differences in hearing were assessed with a multivariable linear regression analysis, incorporating the effect of aging.ResultsLong-term audiometry (median 4.5 years) was available in 67 patients (42%). At ST follow-up, a deterioration of 21.6 decibel was seen compared to baseline at pure-tone averages (PTA) 8-10-12.5 kHz. At LT follow-up, this deterioration further increased with 5 decibel (P = 0.005). Only in CCRT-IV patients was a significant progressive treatment-induced hearing loss seen, at PTA 8-10-12.5 kHz (P = 0.005), PTA 1-2-4 kHz air conduction (P = 0.014), and PTA 0.5-1-2 kHz bone conduction (P = 0.045).ConclusionCCRT-induced hearing impairment was progressive over time, especially in higher frequencies and only in CCRT-IV patients, with a modest deterioration of 5 decibel 4.5 years post-treatment.