Sensorineural Hearing Loss after Combined Intensity Modulated Radiation Therapy and Cisplatin-Based Chemotherapy for Nasopharyngeal Carcinoma

Jin Wang; Yuan-Yuan Chen; An Tai; Xue-Lin Chen; Shao-Ming Huang; Cungen Yang; Yong Bao; Ning-Wei Li; Xiao-Wu Deng; Chong Zhao; Ming Chen; X Allen Li

doi:10.1016/j.tranon.2015.10.003

Sensorineural Hearing Loss after Combined Intensity Modulated Radiation Therapy and Cisplatin-Based Chemotherapy for Nasopharyngeal Carcinoma

Transl Oncol. 2015 Dec;8(6):456-62. doi: 10.1016/j.tranon.2015.10.003.

Authors

Jin Wang¹, Yuan-Yuan Chen², An Tai³, Xue-Lin Chen⁴, Shao-Ming Huang⁵, Cungen Yang³, Yong Bao⁵, Ning-Wei Li⁴, Xiao-Wu Deng⁵, Chong Zhao⁶, Ming Chen⁷, X Allen Li⁸

Affiliations

¹ Departments of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI.
² Departments of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
³ Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI.
⁴ Department of Nasopharyngeal Carcinoma, Cancer Center, Sun Yat-sen University Guangzhou, People's Republic of China.
⁵ Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
⁶ Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China. Electronic address: zhaochong@sysucc.org.cn.
⁷ Departments of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China. Electronic address: Chenming@sysucc.org.cn.
⁸ Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI. Electronic address: ALi@mcw.edu.

Abstract

Purpose: The incidence of sensorineural hearing loss (SNHL) after treatment with combination of intensity-modulated radiation therapy (IMRT) and cisplatin-based chemotherapy in nasopharyngeal carcinoma (NPC) patients was evaluated, and relationships of SNHL with host factors, treatment-related factors, and radiation dosimetric parameters were investigated.

Methods: Fifty-one NPC patients treated with IMRT from 2004 to 2009 were analyzed. All patients received neoadjuvant, concurrent, or adjuvant use of cisplatin. Pure tone audiometry was performed during the follow-up period with a median time of 60months, ranging from 28 to 84months. Correlation of SNHL at low frequencies (pure tone average, 0.5-2kHz) with a series of factors was analyzed.

Results: Among 102 ears, 12.7% had low-frequency SNHL and 42.2% had high-frequency (4kHz) SNHL. The incidence of low-frequency SNHL was greater in patients with age>40, with T-stage 4, or who received cumulative cisplatin dose (CCD)>200mg/m(2) (P=.034, .011, and .003, respectively) and in ears with secretory otitis media (SOM) (P=.002). Several dosimetric parameters were found to be correlated with SNHL. Univariate analysis showed that the minimum radiation dose to 0.1ml highest dose volume (D0.1ml) of the cochlea was the best radiation-related predictive parameter. Multivariate analysis indicated that CCD, SOM, and D0.1ml of cochlea (P=.035, .012, and .022, respectively) were the factors associated with SNHL.

Conclusion: For NPC patients treated with IMRT and chemotherapy, the incidence of treatment-related SNHL was associated with CCD, D0.1ml of cochlea, and SOM.