Prospective study of inner ear radiation dose and hearing loss in head-and-neck cancer patients

Pan, Charlie C.; Eisbruch, Avraham; Lee, Julia S.; Snorrason, Rhonda M.; Haken, Randall K. Ten; Kileny, Paul R.

doi:10.1016/j.ijrobp.2004.08.019

Cited by 175 publications

(148 citation statements)

References 19 publications

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“…It was reported that high-frequency (!2000 Hz) hearing acuity worsened significantly after RT in a dose-dependent fashion. 37 The dosimetric correlations of inner ear or other critical organs spared by conformal RT with patients' organ function impairment, which may contribute to the patients' QOL to different degrees, deserve further evaluation.…”

Section: Discussionmentioning

confidence: 99%

Intensity‐modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma

Fang

Tsai

Chen

et al. 2007

Cancer

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BACKGROUND.It was reported previously that the dosimetric superiority of conformal radiotherapy (RT), either 3‐dimensional conformal RT (3D‐CRT) or intensity‐modulated RT (IMRT), over conventional 2D‐RT translated into clinical benefits for patients with nasopharyngeal carcinoma (NPC). In this study, the authors compared quality‐of‐life (QOL) outcomes of NPC survivors who received treatment with 1 of 4 different RT techniques at a single institute during different periods.METHODS.The authors analyzed QOL data of from 237 patients with NPC who were cancer free for 2 or 3 years when their QOL was assessed. The study population included 152 patients who received conventional RT (2D‐RT, 61 patients; 2D‐RT plus 3D‐CRT boost, 91 patients) and 85 patients who received conformal RT (3D‐CRT, 33 patients; IMRT, 52 patients). The European Organization for the Research and Treatment of Cancer (EORTC) Core QOL questionnaire and the EORTC Head and Neck QOL questionnaire were completed.RESULTS.Compared with patients who received with conventional RT, patients who received conformal RT had both statistically (P < .05) and clinically (a difference in mean scores ≥10 points) significant improvements in the scales of global QOL, pain, appetite loss, senses, speech, social eating, teeth, opening mouth, xerostomia, sticky saliva, and feeling ill. No significant difference was observed in any of the scales that compared 2D‐RT with 2D‐RT plus 3D‐CRT boost or that compared 3D‐CRT with IMRT. Survivors who received conformal RT had a 2.01‐fold higher probability (odds ratio [OR], 2.01; 95% confidence interval [95% CI], 1.19–3.68) of reporting good global QOL and a 2.70‐fold lower probability (OR, 0.37; 95% CI, 0.20–0.66) of reporting a high level of xerostomia than survivors who received conventional RT.CONCLUSIONS.Conformal RT substantially improved head and neck‐related symptoms and broad aspects of QOL for survivors of NPC. Cancer 2007. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Intensity‐modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma

Fang

Tsai

Chen

et al. 2007

Cancer

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“…Our protocol 1 does not impose specific dose constraints on the pituitary gland or the inner ear, when they are located within the clinical target volume, as one ear or both ears are often included in the radiation field and a substantial number of patients subsequently develop transient serous otitis media or sensorineural hearing loss, owing to the proximity of the middle or inner ear to the irradiation field. Hearing preservation has been reported to be significantly related to the radiation dose to the cochlea 2,3 and is found between 0.5 and 2.0 years after irradiation. 3 Similarly, the pituitary gland or the hypothalamus is also generally close to the target volume, and partial pituitary failures are commonly reported during radiation-induced late effects [4][5][6] with speeds of onset ranging from a few months to several years.…”

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confidence: 99%

“…Hearing preservation has been reported to be significantly related to the radiation dose to the cochlea 2,3 and is found between 0.5 and 2.0 years after irradiation. 3 Similarly, the pituitary gland or the hypothalamus is also generally close to the target volume, and partial pituitary failures are commonly reported during radiation-induced late effects [4][5][6] with speeds of onset ranging from a few months to several years. As a wide range of doses are delivered to these critical structures, the objective of this study was to determine the dose-response relationship of the inner ear and the pituitary gland for radiation-induced late effects of photon and proton therapy and to show that generalized equivalent uniform dose (gEUD) may be used as a predictive factor for late complications.…”

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confidence: 99%

Use of gEUD for predicting ear and pituitary gland damage following proton and photon radiation therapy

Marzi¹,

Feuvret²,

Boulé³

et al. 2015

BJR

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Objective: To determine the relationship between the dose to the inner ear or pituitary gland and radiationinduced late effects of skull base radiation therapy. Methods: 140 patients treated between 2000 and 2008 were considered for this study. Hearing loss and endocrine dysfunction were retrospectively reviewed on pre-and post-radiation therapy audiometry or endocrine assessments. Two normal tissue complication probability (NTCP) models were considered (LymanKutcher-Burman and log-logistic) whose parameters were fitted to patient data using receiver operating characteristics and maximum likelihood analysis. The method provided an estimation of the parameters of a generalized equivalent uniform dose (gEUD)-based NTCP after conversion of dose-volume histograms to equivalent doses.

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“…Majority of the studies on SNHL in such patients were published on nasopharyngeal carcinoma patients receiving radiation [3][4][5][6][7][8] except few studies [9][10][11]. However, there is still uncertainty prevailing regarding the pattern of hearing loss, the frequencies affected and the dose of chemoradation effects on the hearing.…”

Section: Discussionmentioning

confidence: 99%

Effects of Chemoradiation on Hearing in Patients with Head and Neck Malignancies: Experience at a Tertiary Referral Care Hospital

Jain¹,

Banerjee²,

Dandinarasaiah

2016

Indian J Otolaryngol Head Neck Surg

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Hearing loss as a side effect in patients with head and neck malignancies with chemoradiation is frequently ignored. Its effects on auditory functions are less studied and there are studies done on animals which are less reliable. The present study was undertaken to identify the type of hearing loss and also to quantify the degree of hearing loss in these patients. A prospective, descriptive study was undertaken in histologically proven head and neck cancer patients treated with cobalt 60 teletherapy who received a dose of 60-66 Grays (Gy) over a period of 6-7 weeks with concurrent Cisplatin 30 mg/m 2 once weekly for 6 weeks. The study included 40 patients (80 ears) undergoing chemoradiation. A baseline pure tone audiometry and impedance audiometry was performed in all the cases prior to the therapy and the same was repeated immediately after the completion of treatment, at 8 and 16 weeks. The changes in pure tone level thresholds and impedance from baseline were correlated with the dose of radiation and chemotherapy. Sensori neural hearing loss (SNHL) and conductive hearing loss was observed in 82.5 and 17.5 % respectively. At the end of 16 weeks, SNHL was found in 27.5, 72.5 and 82.5 % at 2, 4 and 8 kHz respectively. In addition, Eustachian tube dysfunction and Otitis media with effusion was observed in 10 and 7.5 % of patients respectively which lead to conductive hearing loss. Further, it was noted that SNHL in patients with high risk site malignancy (81.8 %) was alarmingly higher compared with low risk site malignancy (18.1 %). The hearing loss at 62, 64 and 66 Gy in comparison to 60 Gy was statistically significant. Hearing loss, specially SNHL was the predominant finding in our study with [80 % of patients showing the inner ear damage due to irradiation of head and neck malignancies. Although, all the frequencies like 2, 4 and 8 kHz were significantly affected, SNHL was more marked in the latter two frequencies. Nearly, 90 % of the patients who had SNHL belonged to high risk site category of head and neck malignancies. Increasing the radiation dosage was directly proportional to the degree of hearing loss with the dose more than 60 Gy causing significant injury to the middle and inner ear.

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Prospective study of inner ear radiation dose and hearing loss in head-and-neck cancer patients

Cited by 175 publications

References 19 publications

Intensity‐modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma

Intensity‐modulated or conformal radiotherapy improves the quality of life of patients with nasopharyngeal carcinoma

Use of gEUD for predicting ear and pituitary gland damage following proton and photon radiation therapy

Effects of Chemoradiation on Hearing in Patients with Head and Neck Malignancies: Experience at a Tertiary Referral Care Hospital

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