RADT-38. Incidence of Hearing Impairment After Definitive Proton Beam Therapy for Malignancies of the Brain and Base of Skull (original) (raw)

Cost-effectiveness analysis of cochlear dose reduction by proton beam therapy for medulloblastoma in childhood

Journal of Radiation Research, 2013

Background: The aim of this study is to evaluate the cost-effectiveness of proton beam therapy with cochlear dose reduction compared with conventional X-ray radiotherapy for medulloblastoma in childhood. Methods: We developed a Markov model to describe health states of 6-year-old children with medulloblastoma after treatment with proton or X-ray radiotherapy. The risks of hearing loss were calculated on cochlear dose for each treatment. Three types of health-related quality of life (HRQOL) of EQ-5D, HUI3 and SF-6D were used for estimation of quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for proton beam therapy compared with X-ray radiotherapy was calculated for each HRQOL. Sensitivity analyses were performed to model uncertainty in these parameters. Results: The

Risk Factors for Hearing Loss in Patients Treated With Intensity-Modulated Radiotherapy for Head-and-Neck Tumors

International Journal of Radiation Oncology*Biology*Physics, 2009

Purpose: Radiotherapy (RT) is a common treatment of head-and-neck carcinoma. The objective of this study was to perform a prospective multivariate assessment of the dose-effect relationship between intensity-modulated RT and hearing loss. Methods and Materials: Pure tone audiometry at 0.250-16 kHz was obtained before and after treatment in 101 patients (202 ears). All patients received full-course intensity-modulated RT (range, 56-70 Gy), with a median cochlear dose of 11.4 Gy (range, 0.2-69.7). Results: Audiometry was performed 1 week before and a median of 9 weeks (range, 1-112) after treatment. The mean hearing deterioration at pure tone average air-conduction 1-2-4 kHz was small (from 28.6 dB HL to 30.1 dB HL). However, individual patients showed clinically significant hearing loss, with 10-dB threshold shift incidences of 13% and 18% at pure tone averages air-conduction 1-2-4 kHz and 8-10-12.5 kHz, respectively. Post-treatment hearing capability was unfavorable in the case of greater inner ear radiation doses (p <0.0001), unfavorable baseline hearing capability (p <0.0001), green-eyed patients (p <0.0001), and older age (p <0.0001). Using multivariate analysis, a prediction of individual hearing capabiltity after treatment was made. Conclusion: RT-induced hearing loss in the mean population is modest. However, clinically significant hearing loss was observed in older patients with green eyes and unfavorable pretreatment hearing. In these patients, the intended radiation dose may be adjusted according to the proposed predictive model, aiming to decrease the risk of ototoxicity. Crown

Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma

American journal of audiology, 2018

Compared to photon-based radiotherapy, protons deliver less radiation to healthy tissue resulting in the potential reduction of late complications such as sensorineural hearing loss (SNHL). We report early auditory outcomes in children treated with proton radiotherapy (PRT) for craniopharyngioma. Conventional frequency (CF = 0.25-8.0 kHz) audiometry, extended high-frequency (EHF = 9.0-16.0 kHz) audiometry, distortion product otoacoustic emission (DPOAE) testing, and speech-in-noise (SIN) assessments were prospectively and longitudinally conducted on 74 children with a median of 2 post-PRT evaluations (range, 1-5) per patient. The median age at PRT initiation was 10 years, and median follow-up time was 2 years. Ototoxicity was classified using the Chang Ototoxicity Grading Scale (Chang & Chinosornvatana, 2010) and the American Speech-Language-Hearing Association (ASHA) criteria (ASHA, 1994). Comparisons were made between baseline and most recent DPOAE levels, with evidence of ototoxi...

Low early ototoxicity rates for pediatric medulloblastoma patients treated with proton radiotherapy

Radiation Oncology, 2011

Background: Hearing loss is common following chemoradiotherapy for children with medulloblastoma. Compared to photons, proton radiotherapy reduces radiation dose to the cochlea for these patients. Here we examine whether this dosimetric advantage leads to a clinical benefit in audiometric outcomes. From 2006From -2009 children treated with proton radiotherapy for medulloblastoma were enrolled on a prospective observational study, through which they underwent pre-and 1 year post-radiotherapy pure-tone audiometric testing. Ears with moderate to severe hearing loss prior to therapy were censored, leaving 35 ears in 19 patients available for analysis.

Sensorineural Hearing Loss after Radiotherapy for Brain Tumors in Radiotherapy Department Erbil City

Background: Hearing loss is a well-known complication of radiotherapy among patients treated for tumors that arise in the head and neck region, more specifically, among those treated with postoperative radiotherapy for parotid gland tumors. The purpose of this study was to evaluate the effects of radiotherapy on hearing function in patients who underwent radiotherapy for tumors of the brain. Methods & Materials: In this study pure ton Audiometer was used to measure hearing loss. The mean dose on middle ear, cochlea, and Eustachian tube was estimated with a Linear accelerator (linac.) CT-Scan planning. Bone conduction hearing thresholds were performed before treatment and at 1 week, 6 months& 1year after completion of radiotherapy. Results: A hearing loss of >20 dB in 8 frequencies was found of the 40 patients included in the study. Patients with an asymmetrical hearing loss received a higher mean dose on the hearing structures (p < .001). The threshold dose for clinically rele...

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

International Journal of Radiation Oncology*Biology*Physics, 2005

Purpose: To determine the relationship between the radiation dose to the inner ear and long-term hearing loss. Methods and Materials: Eligible patients included those receiving curative radiotherapy (RT) for head-and-neck cancer. After enrollment, patients underwent three-dimensional conformal RT planning and delivery (180 -200 cGy/fraction) appropriate for their disease site and stage. The inner ear was contoured on axial CT planning images. Dose-volume histograms, as well as the mean and maximal dose for each structure, were calculated. Patients underwent pure tone audiometry at baseline (before treatment) and 1, 6, 12, 24, and 36 months after RT. The threshold level (the greater the value, the more hearing loss) in decibels was recorded for 250, 500, 1000, 2000, 4000, and 8000 Hz. For patients receiving predominantly unilateral RT, the contralateral ear served as the de facto control. The differences in threshold level between the ipsilateral and contralateral ears were calculated, and the temporal pattern and dose-response relation of hearing loss were analyzed using statistical methods that take into account the correlation between two ears in the same subject and repeated, sequential measurements of each subject. Results: Of the 40 patients enrolled in this study, 35 qualified for analysis. Four patients who received concurrent chemotherapy and RT were analyzed separately. The 31 unilaterally treated patients received a median dose of 47.4 Gy (range, 14.1-68.8 Gy) to the ipsilateral inner ear and 4.2 Gy (range, 0.5-31.3 Gy) to the contralateral inner ear. Hearing loss was associated with the radiation dose received by the inner ear (loss of 210dB was observed in ears receiving >45 Gy) and was most appreciable in the higher frequencies (>2000 Hz). For a 60-year-old patient with no previous hearing loss in either ear, after receiving 45 Gy, the ipsilateral ear, according to our clinical model, would have a 19.3-dB (95% confidence interval [CI], 15.5-23.0) and 5.4-dB (95% CI, 3.5-7.5) hearing decrement compared with the contralateral ear for 8000 Hz and 1000 Hz, respectively. Age and an initial hearing difference within an ear pair also affected hearing loss. The baseline hearing threshold was inversely related to radiation-induced hearing loss. The degree of hearing loss was dependent on the frequency tested, age, baseline hearing, and baseline difference in hearing between a patient's two ears. Conclusion: High-frequency (>2000 Hz) hearing acuity worsens significantly after RT in a dose-dependent fashion. A larger number of patients needs to be studied to validate these results. This knowledge can be applied to create guidelines regarding future dose limits to the auditory apparatus for patients undergoing head-andneck RT.

Frequency of Radiotherapy Induced Hearing Loss in Patients of Head and Neck Cancers

IOSR Journals , 2019

Background: Radiotherapy is a treatment modality of Head & Neck cancer.Hearing loss is a common complication of radiation treatment, which hampers the quality of life of patients. Methods: An institutional based prospective study was carried out in ENT opd of our institution.Patients with newly diagnosed Head & Neck cancer were included in the study.41 patients were evaluted pre & post radiotherapy indifferent settings. Results: Oropharynx(41.46%) is the most commonest site of H and N cancer in our study, followed by Larynx(24.4%). Hearing loss was found in 9 patients (21.95 %). Among them conductive hearing loss was seen in 6 patients (66.6%) and mixed type of hearing loss was seen in 3 patients(33.4%). Conclusion:For better rehabilitation of Head & Neck cancer patients undergoing radiotherapy,hearing loss assessment should be done.

Effect of Radiotherapy on Hearing Thresholds in Patients of Head and Neck Malignancies

The Internet Journal of Otorhinolaryngology, 2014

Objective: To study the effect of radiotherapy on hearing in patients with head and neck cancer. Methods: A prospective study was undertaken comprising of 30 patients (60 ears) with histopathologically proven head and neck cancer in the age group of 30-75 years. Hearing status was evaluated before and after one month of radiotherapy treatment by pure tone audiometry (PTA) and brainstem evoked response audiometry (BERA). Results: Pre-radiation hearing assessment revealed normal hearing in 20% (12 ears), mild hearing loss in 33.3% (20 ears), moderate hearing loss in 28.3% (17 ears) and moderately severe hearing loss in 18.3% (11 ears). Post-radiation hearing remained same in 58.3% (35 ears), deteriorated in 33.3% (20 ears), and improved in 8.3% (5 ears). Post radiotherapy hearing loss was seen more common in patients older than 50 years of age and who had abnormal pre-radiation hearing status. Conclusion: Hearing loss can occur in a significant number of patients undergoing radiothera...

Ototoxicity after radiotherapy for head and neck tumors

International Journal of Radiation Oncology Biology Physics, 2007

Purpose: To investigate the incidence of radiation-induced ototoxicity according to the total dose delivered to specific parts of the auditory system, fractionation, and chemotherapy. Methods and Materials: Records of 325 patients treated for primary extracranial head and neck tumors with curative intent who received radiotherapy between 1964 and 2000 (median follow-up, 5.4 years) were retrospectively reviewed. Reconstructions of the treatment plans were generated to estimate the doses received by components of the auditory system. Results: Radiotherapy-induced morbidity developed in 41.8% of patients (external ear, 33.2%; middle ear, 28.6%; and inner ear, 26.8%). Univariate/multivariate analyses indicate that total dose received by parts of the auditory system seem to be significant, though fractionation and chemoradiation may contribute to the incidence of ototoxicities. Sensorineural hearing loss (SNHL) was observed in 49 patients (15.1%). Univariate and multivariate analyses indicated that age (p ‫؍‬ 0.0177 and p ‫؍‬ 0.005) and dose to cochlea (p < 0.0001 and p < 0.0001) were significant, and chemoradiation (p ‫؍‬ 0.0281 and p ‫؍‬ 0.006) may increase the incidence of SNHL.

Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: a phase 2 single-arm study

The Lancet Oncology, 2016

Background Compared with traditional photon radiotherapy, proton radiotherapy irradiates less normal tissue and might improve health outcomes associated with photon radiotherapy by reducing toxic effects to normal tissue. We did a trial to assess late complications, acute side-effects, and survival associated with proton radiotherapy in children with medulloblastoma. Methods In this non-randomised, open-label, single-centre, phase 2 trial, we enrolled patients aged 3-21 years who had medulloblastoma. Patients had craniospinal irradiation of 18-36 Gy radiobiological equivalents (GyRBE) delivered at 1•8 GyRBE per fraction followed by a boost dose. The primary outcome was cumulative incidence of ototoxicity at 3 years, graded with the Pediatric Oncology Group ototoxicity scale (0-4), in the intention-to-treat population. Secondary outcomes were neuroendocrine toxic effects and neurocognitive toxic effects, assessed by intention-to-treat. This study is registered at ClinicalTrials.gov, number NCT00105560. Findings We enrolled 59 patients from May 20, 2003, to Dec 10, 2009: 39 with standard-risk disease, six with intermediate-risk disease, and 14 with high-risk disease. 59 patients received chemotherapy. Median follow-up of survivors was 7•0 years (IQR 5•2-8•6). All patients received the intended doses of proton radiotherapy. The median craniospinal irradiation dose was 23•4 GyRBE (IQR 23•4-27•0) and median boost dose was 54•0 GyRBE (IQR 54•0-54•0). Four (9%) of 45 evaluable patients had grade 3-4 ototoxicity according to Pediatric Oncology Group ototoxicity scale in both ears at follow-up, and three (7%) of 45 patients developed grade 3-4 ototoxicity in one ear, although one later reverted to grade 2. The cumulative incidence of grade 3-4 hearing loss at 3 years was 12% (95% CI 4-25). At 5 years, it was 16% (95% CI 6-29). Pediatric Oncology Group hearing ototoxicity score at a follow-up of 5•0 years (IQR 2•9-6•4) was the same as at baseline or improved by 1 point in 34 (35%) of 98 ears, worsened by 1 point in 21 (21%), worsened by 2 points in 35 (36%), worsened by 3 points in six (6%), and worsened by 4 points in two (2%). Full Scale Intelligence Quotient decreased by 1•5 points (95% CI 0•9-2•1) per year after median follow-up up of 5•2 years (IQR 2•6-6•4), driven by decrements in processing speed and verbal comprehension index. Perceptual reasoning index and working memory did not change significantly. Cumulative incidence of any neuroendocrine deficit at 5 years was 55% (95% CI 41-67), with growth hormone deficit being most common. We recorded no cardiac, pulmonary, or gastrointestinal late toxic effects. 3-year progression-free survival was 83% (95% CI 71-90) for all patients. In post-hoc analyses, 5-year progression-free survival was 80% (95% CI 67-88) and 5-year overall survival was 83% (95% CI 70-90). Interpretation Proton radiotherapy resulted in acceptable toxicity and had similar survival outcomes to those noted with conventional radiotherapy, suggesting that the use of the treatment may be an alternative to photon-based treatments. Funding US National Cancer Institute and Massachusetts General Hospital.