Relative contributions of radiation and cisplatin-based chemotherapy to sensorineural hearing loss in head-and-neck cancer patients

Abstract

Background

One of the debilitating complications of head and neck cancer radiotherapy is hearing loss.

Objective

To quantify the magnitude of sensory neural hearing loss (SNHL) in the head and neck cancer patients undergoing chemoradiation therapy.

Design and methods

This is a prospective study. Eighty patients with head and neck cancers and undergoing volumetric arc therapy were taken up for the study. Regular audiological evaluation was done. The changes in audiological parameters from baseline are correlated with cochlear dose.

Results

Cochlea received maximum doses of up to 28.52 Gy without causing SNHL in the absence of chemotherapy. But in concurrent chemoradiotherapy, hearing loss was found at least dose of 9 Gy at frequency range of 4 KHz–8 KHz. The risk of SNHL is independent of cumulative doses of Cisplatin. In 106 ears receiving concurrent chemoradiation, 82.1% and 74.5% ears had sensorineural hearing loss at 4 KHz and 8 KHz respectively, following the completion of treatment. Otoacoustic emissions in the chemoradiation group showed a significant change at the completion of treatment.

Conclusion and significance

Volumetric arc therapy have facilitated sparing of cochlea (< 40 Gy). This has resulted in better clinical outcome in terms of SNHL. The inclusion of concurrent cisplatin chemotherapy is a significant risk factor for the development of SNHL at higher frequencies.

Chinese abstract

背景：头颈癌放疗的严重并发症之一是听力损失。

目的：量化头颈癌患者经放化疗后感觉神经性听力损失（SNHL）的程度。

设计和方法：这是一项前瞻性研究。八十名接受容积弧疗法的头颈癌患者被纳入研究。进行了定期听力学评估。将听力学参数自基线的变化与耳蜗剂量相关联。

结果：在没有化疗的情况下, 耳蜗接受了高达 28.52 Gy 的最大剂量而没有引起 SNHL。但在同时进行的放化疗中, 至少在 9 Gy 剂量下, 在频率范围为 4 KHz–8 KHz, 发现有听力损失。 SNHL 的风险与顺铂的累积剂量无关。在同时接受放化疗的106 只耳朵中, 82.1% 和 74.5% 的耳朵在治疗完成后分别在 4 KHz 和 8 KHz发生感觉神经性听力损失。放化疗组的耳声发射在治疗完成时表现明显的变化。

结论和意义：容积弧治疗有助于保留耳蜗 (< 40 Gy)。就 SNHL 而言, 这导致了更好的临床结果。纳入同步顺铂化疗是发生较高频率SNHL 的重要危险因素。

Keywords:

• Sensorineural hearing loss
• cochlear dose
• chemotherapy
• radiotherapy
• head and neck cancer

Limitations of the study

Absence of cohorts with cisplatin dose stratifications (High dose and low dose), small patient size, loss of 20% of patients at the 1 year follow up and unequal distribution of gender are important limitation of this study.

Ethical approval

The present study was approved by institutional ethical committee –All India Institute of Medical Sciences Jodhpur, Rajasthan, India. (AIIMS/IEC/2018/827)

Informed consent

Patients were enrolled after obtaining informed consent for publication and participation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Author’s contributions

All authors were equally involved in

• Conception of the work

• Data collection

• Data analysis and interpretation

• Drafting the article

• Critical revision of the article

• Final approval of the version to be published