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Impact of radiation technique, radiation fraction dose, and total cisplatin dose on hearing

Retrospective analysis of 29 medulloblastoma patients

Effekte von Bestrahlungstechnik, Fraktionierung und Cisplatin-Gesamtdosis auf das Hörvermögen

Retrospektive Analyse von 29 Patienten mit Medulloblastom

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Abstract

Purpose

To analyze the incidence and degree of sensorineural hearing loss (SNHL) resulting from different radiation techniques, fractionation dose, mean cochlear radiation dose (Dmean), and total cisplatin dose.

Material and methods

In all, 29 children with medulloblastoma (58 ears) with subclinical pretreatment hearing thresholds participated. Radiotherapy (RT) and cisplatin had been applied sequentially according to the HIT MED Guidance. Audiological outcomes up to the latest follow-up (median 2.6 years) were compared.

Results

Bilateral high-frequency SNHL was observed in 26 patients (90%). No significant differences were found in mean hearing threshold between left and right ears at any frequency. A significantly better audiological outcome (p < 0.05) was found after tomotherapy at the 6 kHz bone-conduction threshold (BCT) and left-sided 8 kHz air-conduction threshold (ACT) than after a combined radiotherapy technique (CT). Fraction dose was not found to have any impact on the incidence, degree, and time-to-onset of SNHL. Patients treated with CT had a greater risk of SNHL at high frequencies than tomotherapy patients even though Dmean was similar. Increase in severity of SNHL was seen when the total cisplatin dose reached above 210 mg/m2, with the highest abnormal level found 8–12 months after RT regardless of radiation technique or fraction dose.

Conclusion

The cochlear radiation dose should be kept as low as possible in patients who receive simultaneous cisplatin-based chemotherapy. The risk of clinically relevant HL was shown when Dmean exceeds 45 Gy independent of radiation technique or radiation regime. Cisplatin ototoxicity was shown to have a dose-dependent effect on bilateral SNHL, which was more pronounced in higher frequencies.

Zusammenfassung

Ziel

Analyse von Inzidenz und Schweregrad einer sensorineuralen Schwerhörigkeit („sensorineural hearing loss“, SNHL) infolge der Wirkung unterschiedlicher Bestrahlungstechniken, Fraktionierungen, mittlerer kochleärer Strahlendosen (Dmean) und Cisplatin-Gesamtdosen.

Material und Methoden

Es wurden 29 Kinder (entsprechend 58 Ohren) mit Medulloblastom und mit subklinischen prätherapeutischen Hörschwellen analysiert. Radiotherapie und Cisplatin-basierte Chemotherapie wurden sequenziell gemäß dem HIT-MED-Protokoll eingesetzt. Verglichen wurden unter laufender Therapie und posttherapeutisch gewonnene audiologische Ergebnisse (mediane Nachbeobachtungszeit 2,6 Jahre).

Ergebnisse

Eine bilaterale Hochtonschwerhörigkeit wurde bei 26 (90 %) Patienten beobachtet. Ein Vergleich linker und rechter Ohren zeigte bei keiner Frequenz einen signifikanten Unterschied im mittleren Hörverlust. Eine signifikant geringere Schädigung (p < 0,05) ergab sich für Tomotherapie bei 6 kHz in der Knochenleitungs- und linksseitig bei 8 kHz in der Luftleitungsmessung im Vergleich zu kombinierter Bestrahlungstechnik. Die Fraktionierungsdosis zeigte keinen Effekt auf Inzidenz, Schweregrad und Latenzzeit der Schwerhörigkeit. Bei gleicher Dmean ergab sich nach kombinierter Bestrahlungstechnik ein höheres Risiko für einen Hörverlust im Hochtonbereich als nach einer Tomotherapie. Eine Zunahme des Schweregrads der Hörschädigung wurde bei einer Cisplatin-Gesamtdosis über 210 mg/m2 festgestellt, mit den höchsten abnormen Werten 8–12 Monate nach Ende der Bestrahlung, unabhängig von der Bestrahlungstechnik und von Fraktionierungsschemata.

Schlussfolgerung

Die Innenohrdosis/Dosis an der Kochlea sollte für Patienten mit simultaner Cisplatin-Gabe so niedrig wie möglich gehalten werden. Unabhängig von Fraktionierung und Technik besteht das Risiko eines klinisch relevanten Hörverlustes bei einer mittleren Innenohrdosis >45 Gy. Zudem zeigte die Ototoxizität durch Cisplatin einen dosisabhängigen Effekt auf einen bilateralen, besonders in den hohen Frequenzen betonten SNHL.

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Authors and Affiliations

  1. Department of Radiotherapy and Radiooncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Muenster, Germany

    Sergiu Scobioala MD, Christopher Kittel, Fatemeh Ebrahimi, Heidi Wolters Ph.D & Hans Theodor Eich M.D. Ph.D.

  2. Department of Phoniatrics and Pediatric Audiology, University Hospital of Muenster, Muenster, Germany

    Ross Parfitt, Peter Matulat & Antoinette am Zehnhoff-Dinnesen M.D. Ph.D.

Authors
  1. Sergiu Scobioala MD
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  2. Ross Parfitt
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  4. Christopher Kittel
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  8. Hans Theodor Eich M.D. Ph.D.
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Correspondence to Sergiu Scobioala MD.

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Conflict of interest

S. Scobioala, R. Parfitt, P. Matulat, C. Kittel, F. Ebrahimi, H. Wolters, A. am Zehnhoff-Dinnesen and H.T. Eich declare that they have no competing interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Scobioala, S., Parfitt, R., Matulat, P. et al. Impact of radiation technique, radiation fraction dose, and total cisplatin dose on hearing. Strahlenther Onkol 193, 910–920 (2017). https://doi.org/10.1007/s00066-017-1205-y

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