Skip to main content

Abstract

Hearing is a fundamental sensory input required for language acquisition and social interaction. Radiotherapy fields that involve the cochlea are associated with hearing loss at dosages over 30 Gy. Cisplatin is known to cause hearing loss in a high percentage of patients, especially when dosages exceed 300 mg/m2. Radiotherapy to the cochlea and cisplatin administration combine to produce hearing loss in most patients. Children with medulloblastoma are at high risk of developing hearing loss due to these factors. Proton beam radiotherapy offers the possibility of minimizing cochlear radiation dose and might help to prevent hearing loss. Predisposing factors, pathophysiology, clinical features, and consequences of hearing loss in the pediatric brain tumor population are discussed. Brief mention is made of therapeutic interventions, prevention, and radiotherapy dose tolerances for this select group of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Adunka OF, Buchman CA (2007) Cochlear implantation in the irradiated temporal bone. J Laryngol Otol 121(1):83–86. doi:10.1017/S0022215106002180

    Article  CAS  PubMed  Google Scholar 

  • Asenov DR, Kaga K, Tsuzuku T (2007) Changes in the audiograms of a nasopharyngeal cancer patient during the course of treatment: a temporal bone histopathological study. Acta Otolaryngol 127(10):1105–1110. doi:10.1080/00016480601127026

    Article  PubMed  Google Scholar 

  • Bertolini P, Lassalle M, Mercier G, Raquin MA, Izzi G, Corradini N, Hartmann O (2004) Platinum compound-related ototoxicity in children: long-term follow-up reveals continuous worsening of hearing loss. J Pediatr Hematol Oncol 26(10):649–655

    Article  Google Scholar 

  • Bess FH, Dodd-Murphy J, Parker RA (1998) Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear Hear 19(5):339–354

    Article  CAS  PubMed  Google Scholar 

  • Bohne BA, Marks JE, Glasgow GP (1985) Delayed effects of ionizing radiation on the ear. Laryngoscope 95(7 Pt 1):818–828

    CAS  PubMed  Google Scholar 

  • Brock PR, Bellman SC, Yeomans EC, Pinkerton CR, Pritchard J (1991) Cisplatin ototoxicity in children: a practical grading system. Med Pediatr Oncol 19(4):295–300

    Article  CAS  PubMed  Google Scholar 

  • Brock PR, Knight KR, Freyer DR, Campbell KC, Steyger PS, Blakley BW, Rassekh SR, Chang KW, Fligor BJ, Rajput K, Sullivan M, Neuwelt EA (2012) Platinum-induced ototoxicity in children: a consensus review on mechanisms, predisposition, and protection, including a new International Society of Pediatric Oncology Boston ototoxicity scale. J Clin Oncol 30(19):2408–2417. doi:10.1200/JCO.2011.39.1110

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chang KW, Chinosornvatana N (2010) Practical grading system for evaluating cisplatin ototoxicity in children. J Clin Oncol 28(10):1788–1795. doi:10.1200/JCO.2009.24.4228

    Article  CAS  PubMed  Google Scholar 

  • Chao C, Saito S, Anderson CW, Appella E, Xu Y (2000) Phosphorylation of murine p53 at ser-18 regulates the p53 responses to DNA damage. Proc Natl Acad Sci U S A 97(22):11936–11941. doi:10.1073/pnas.220252297

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chen WC, Jackson A, Budnick AS, Pfister DG, Kraus DH, Hunt MA, Stambuk H, Levegrun S, Wolden SL (2006) Sensorineural hearing loss in combined modality treatment of nasopharyngeal carcinoma. Cancer 106(4):820–829. doi:10.1002/cncr.21683

    Article  PubMed  Google Scholar 

  • Chua DY, Tan HK (2007) Successful rehabilitation with cochlear implant in post-irradiation induced hearing loss in nasopharyngeal carcinoma patient. Ann Acad Med Singapore 36(1):74–77

    PubMed  Google Scholar 

  • Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31(5):1341–1346. doi:10.1016/0360-3016(95)00060-C

    Article  CAS  PubMed  Google Scholar 

  • Dickey DT, YJ W, Muldoon LL, Neuwelt EA (2005) Protection against cisplatin-induced toxicities by N-acetylcysteine and sodium thiosulfate as assessed at the molecular, cellular, and in vivo levels. J Pharmacol Exp Ther 314(3):1052–1058. doi:10.1124/jpet.105.087601

    Article  CAS  PubMed  Google Scholar 

  • Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21(1):109–122

    Article  CAS  PubMed  Google Scholar 

  • Fligor BJ, Krasker JD, Villaluna D, Krailo M, Frazier AL (2012) “Accelerated ear-age”: a new measure of chemotherapy-induced ototoxicity. Pediatr Blood Cancer 59(5):947–949. doi:10.1002/pbc.24169

    Article  PubMed  Google Scholar 

  • Fouladi M, Chintagumpala M, Ashley D, Kellie S, Gururangan S, Hassall T, Gronewold L, Stewart CF, Wallace D, Broniscer A, Hale GA, Kasow KA, Merchant TE, Morris B, Krasin M, Kun LE, Boyett JM, Gajjar A (2008) Amifostine protects against cisplatin-induced ototoxicity in children with average-risk medulloblastoma. J Clin Oncol 26(22):3749–3755. doi:10.1200/JCO.2007.14.3974

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Glover D, Glick JH, Weiler C, Hurowitz S, Kligerman MM (1986) WR-2721 protects against the hematologic toxicity of cyclophosphamide: a controlled phase II trial. J Clin Oncol 4(4):584–588

    Article  CAS  PubMed  Google Scholar 

  • Glover D, Glick JH, Weiler C, Fox K, Guerry D (1987) WR-2721 and high-dose cisplatin: an active combination in the treatment of metastatic melanoma. J Clin Oncol 5(4):574–578

    Article  CAS  PubMed  Google Scholar 

  • Grewal S, Merchant T, Reymond R, McInerney M, Hodge C, Shearer P (2010) Auditory late effects of childhood cancer therapy: a report from the Children’s Oncology Group. Pediatrics 125(4):e938–e950. doi:10.1542/peds.2009-1597

    Article  PubMed  PubMed Central  Google Scholar 

  • Gurney JG, Krull KR, Kadan-Lottick N, Nicholson HS, Nathan PC, Zebrack B, Tersak JM, Ness KK (2009) Social outcomes in the Childhood Cancer Survivor Study cohort. J Clin Oncol 27(14):2390–2395. doi:10.1200/JCO.2008.21.1458

    Article  PubMed  PubMed Central  Google Scholar 

  • Hirano E, Fuji H, Onoe T, Kumar V, Shirato H, Kawabuchi K (2014) Cost-effectiveness analysis of cochlear dose reduction by proton beam therapy for medulloblastoma in childhood. J Radiat Res 55(2):320–327. doi:10.1093/jrr/rrt112

    Article  PubMed  Google Scholar 

  • Hoistad DL, Ondrey FG, Mutlu C, Schachern PA, Paparella MM, Adams GL (1998) Histopathology of human temporal bone after cis-platinum, radiation, or both. Otolaryngol Head Neck Surg 118(6):825–832

    Article  CAS  PubMed  Google Scholar 

  • Honore HB, Bentzen SM, Moller K, Grau C (2002) Sensori-neural hearing loss after radiotherapy for nasopharyngeal carcinoma: individualized risk estimation. Radiother Oncol 65(1):9–16

    Article  PubMed  Google Scholar 

  • Hua C, Bass JK, Khan R, Kun LE, Merchant TE (2008) Hearing loss after radiotherapy for pediatric brain tumors: effect of cochlear dose. Int J Radiat Oncol Biol Phys 72(3):892–899. doi:10.1016/j.ijrobp.2008.01.050

    Article  PubMed  Google Scholar 

  • Hyppolito MA, de Oliveira JA, Rossato M (2006) Cisplatin ototoxicity and otoprotection with sodium salicylate. Eur Arch Otorhinolaryngol 263(9):798–803. doi:10.1007/s00405-006-0070-6

    Article  PubMed  Google Scholar 

  • Jimenez RB, Sethi R, Depauw N, Pulsifer MB, Adams J, McBride SM, Ebb D, Fullerton BC, Tarbell NJ, Yock TI, Macdonald SM (2013) Proton radiation therapy for pediatric medulloblastoma and supratentorial primitive neuroectodermal tumors: outcomes for very young children treated with upfront chemotherapy. Int J Radiat Oncol Biol Phys 87(1):120–126. doi:10.1016/j.ijrobp.2013.05.017

    Article  PubMed  Google Scholar 

  • Kemp G, Rose P, Lurain J, Berman M, Manetta A, Roullet B, Homesley H, Belpomme D, Glick J (1996) Amifostine pretreatment for protection against cyclophosphamide-induced and cisplatin-induced toxicities: results of a randomized control trial in patients with advanced ovarian cancer. J Clin Oncol 14(7):2101–2112

    Article  CAS  PubMed  Google Scholar 

  • Kim CS, Shin SO (1994) Ultrastructural changes in the cochlea of the guinea pig after fast neutron irradiation. Otolaryngol Head Neck Surg 110(4):419–427

    Article  CAS  PubMed  Google Scholar 

  • Knight KR, Kraemer DF, Neuwelt EA (2005) Ototoxicity in children receiving platinum chemotherapy: underestimating a commonly occurring toxicity that may influence academic and social development. J Clin Oncol 23(34):8588–8596. doi:10.1200/JCO.2004.00.5355

    Article  PubMed  Google Scholar 

  • Kolesnick R (2002) The therapeutic potential of modulating the ceramide/sphingomyelin pathway. J Clin Invest 110(1):3–8. doi:10.1172/JCI16127

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kwong DL, Wei WI, Sham JS, Ho WK, Yuen PW, Chua DT, Au DK, Wu PM, Choy DT (1996) Sensorineural hearing loss in patients treated for nasopharyngeal carcinoma: a prospective study of the effect of radiation and cisplatin treatment. Int J Radiat Oncol Biol Phys 36(2):281–289

    Article  CAS  PubMed  Google Scholar 

  • Lafay-Cousin L, Purdy E, Huang A, Cushing SL, Papaioannou V, Nettel-Aguirre A, Bouffet E (2013) Early cisplatin induced ototoxicity profile may predict the need for hearing support in children with medulloblastoma. Pediatr Blood Cancer 60(2):287–292. doi:10.1002/pbc.24307

    Article  CAS  PubMed  Google Scholar 

  • Lannering B, Rutkowski S, Doz F, Pizer B, Gustafsson G, Navajas A, Massimino M, Reddingius R, Benesch M, Carrie C, Taylor R, Gandola L, Bjork-Eriksson T, Giralt J, Oldenburger F, Pietsch T, Figarella-Branger D, Robson K, Forni M, Clifford SC, Warmuth-Metz M, von Hoff K, Faldum A, Mosseri V, Kortmann R (2012) Hyperfractionated versus conventional radiotherapy followed by chemotherapy in standard-risk medulloblastoma: results from the randomized multicenter HIT-SIOP PNET 4 trial. J Clin Oncol 30(26):3187–3193. doi:10.1200/JCO.2011.39.8719

    Article  PubMed  Google Scholar 

  • Leach W (1965) Irradiation of the ear. J Laryngol Otol 79(10):870–880

    Article  CAS  PubMed  Google Scholar 

  • Leighton SE, Kay R, Leung SF, Woo JK, Van Hasselt CA (1997) Auditory brainstem responses after radiotherapy for nasopharyngeal carcinoma. Clin Otolaryngol Allied Sci 22(4):350–354

    Article  CAS  PubMed  Google Scholar 

  • Li Y, Womer RB, Silber JH (2004) Predicting cisplatin ototoxicity in children: the influence of age and the cumulative dose. Eur J Cancer 40(16):2445–2451. doi:10.1016/j.ejca.2003.08.009

    Article  CAS  PubMed  Google Scholar 

  • Linskey ME, Johnstone PA (2003) Radiation tolerance of normal temporal bone structures: implications for gamma knife stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 57(1):196–200

    Article  PubMed  Google Scholar 

  • Low WK, Tan MG, Sun L, Chua AW, Goh LK, Wang DY (2006) Dose-dependent radiation-induced apoptosis in a cochlear cell-line. Apoptosis 11:2127–2136

    Article  PubMed  Google Scholar 

  • Low WK, Sun L, Tan MG, Chua AW, Wang DY (2008) l-N-Acetylcysteine protects against radiation-induced apoptosis in a cochlear cell line. Acta Otolaryngol 128(4):440–445. doi:10.1080/00016480701762490

    Article  CAS  PubMed  Google Scholar 

  • Low WK, Tan MG, Chua AW, Sun L, Wang DY (2009) 12th Yahya Cohen Memorial Lecture: the cellular and molecular basis of radiation-induced sensori-neural hearing loss. Ann Acad Med Singapore 38(1):91–94

    PubMed  Google Scholar 

  • Madasu R, Ruckenstein MJ, Leake F, Steere E, Robbins KT (1997) Ototoxic effects of supradose cisplatin with sodium thiosulfate neutralization in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 123(9):978–981

    Article  CAS  PubMed  Google Scholar 

  • Mailhot Vega RB, Kim J, Bussiere M, Hattangadi J, Hollander A, Michalski J, Tarbell NJ, Yock T, MacDonald SM (2013) Cost effectiveness of proton therapy compared with photon therapy in the management of pediatric medulloblastoma. Cancer 119(24):4299–4307. doi:10.1002/cncr.28322

    Article  PubMed  Google Scholar 

  • Merchant TE, Gould CJ, Xiong X, Robbins N, Zhu J, Pritchard DL, Khan R, Heideman RL, Krasin MJ, Kun LE (2004) Early neuro-otologic effects of three-dimensional irradiation in children with primary brain tumors. Int J Radiat Oncol Biol Phys 58(4):1194–1207. doi:10.1016/j.ijrobp.2003.07.008

    Article  PubMed  Google Scholar 

  • Merchant TE, Hua CH, Shukla H, Ying X, Nill S, Oelfke U (2008) Proton versus photon radiotherapy for common pediatric brain tumors: comparison of models of dose characteristics and their relationship to cognitive function. Pediatr Blood Cancer 51(1):110–117. doi:10.1002/pbc.21530

    Article  PubMed  Google Scholar 

  • Merchant TE, Conklin HM, Wu S, Lustig RH, Xiong X (2009) Late effects of conformal radiation therapy for pediatric patients with low-grade glioma: prospective evaluation of cognitive, endocrine, and hearing deficits. J Clin Oncol 27(22):3691–3697. doi:10.1200/JCO.2008.21.2738

    Article  PubMed  PubMed Central  Google Scholar 

  • Moeller BJ, Chintagumpala M, Philip JJ, Grosshans DR, McAleer MF, Woo SY, Gidley PW, Vats TS, Mahajan A (2011) Low early ototoxicity rates for pediatric medulloblastoma patients treated with proton radiotherapy. Radiat Oncol 6:58. doi:10.1186/1748-717X-6-58

    Article  PubMed  PubMed Central  Google Scholar 

  • Mujica-Mota M, Waissbluth S, Daniel SJ (2013) Characteristics of radiation-induced sensorineural hearing loss in head and neck cancer: a systematic review. Head Neck 35(11):1662–1668. doi:10.1002/hed.23201

    Article  PubMed  Google Scholar 

  • Mujica-Mota MA, Lehnert S, Devic S, Gasbarrino K, Daniel SJ (2014) Mechanisms of radiation-induced sensorineural hearing loss and radioprotection. Hear Res 312:60–68. doi:10.1016/j.heares.2014.03.003

    Article  CAS  PubMed  Google Scholar 

  • Muldoon LL, Pagel MA, Kroll RA, Brummett RE, Doolittle ND, Zuhowski EG, Egorin MJ, Neuwelt EA (2000) Delayed administration of sodium thiosulfate in animal models reduces platinum ototoxicity without reduction of antitumor activity. Clin Cancer Res 6(1):309–315

    CAS  PubMed  Google Scholar 

  • National Cancer Institue: Common Terminology Criteria for Adverse Events, Version 4.03. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf

  • Op de Beeck K, Schacht J, Van Camp G (2011) Apoptosis in acquired and genetic hearing impairment: the programmed death of the hair cell. Hear Res 281(1–2):18–27. doi:10.1016/j.heares.2011.07.002

    Article  PubMed Central  Google Scholar 

  • Pan CC, Eisbruch A, Lee JS, Snorrason RM, Ten Haken RK, Kileny PR (2005) Prospective study of inner ear radiation dose and hearing loss in head-and-neck cancer patients. Int J Radiat Oncol Biol Phys 61(5):1393–1402. doi:10.1016/j.ijrobp.2004.08.019

    Article  PubMed  Google Scholar 

  • Paris F, Fuks Z, Kang A, Capodieci P, Juan G, Ehleiter D, Haimovitz-Friedman A, Cordon-Cardo C, Kolesnick R (2001) Endothelial apoptosis as the primary lesion initiating intestinal radiation damage in mice. Science 293(5528):293–297. doi:10.1126/science.1060191

    Article  CAS  PubMed  Google Scholar 

  • Paulino AC, Lobo M, Teh BS, Okcu MF, South M, Butler EB, Su J, Chintagumpala M (2010) Ototoxicity after intensity-modulated radiation therapy and cisplatin-based chemotherapy in children with medulloblastoma. Int J Radiat Oncol Biol Phys 78(5):1445–1450. doi:10.1016/j.ijrobp.2009.09.031

    Article  CAS  PubMed  Google Scholar 

  • Pavy JJ, Denekamp J, Letschert J, Littbrand B, Mornex F, Bernier J, Gonzales-Gonzales D, Horiot JC, Bolla M, Bartelink H (1995) EORTC Late Effects Working Group. Late effects toxicity scoring: the SOMA scale. Radiother Oncol 35(1):11–15

    Article  CAS  PubMed  Google Scholar 

  • Polkinghorn WR, Dunkel IJ, Souweidane MM, Khakoo Y, Lyden DC, Gilheeney SW, Becher OJ, Budnick AS, Wolden SL (2011) Disease control and ototoxicity using intensity-modulated radiation therapy tumor-bed boost for medulloblastoma. Int J Radiat Oncol Biol Phys 81(3):e15–e20. doi:10.1016/j.ijrobp.2010.11.081

    Article  PubMed  Google Scholar 

  • Roland JT Jr, Cosetti M, Liebman T, Waltzman S, Allen JC (2010) Cochlear implantation following treatment for medulloblastoma. Laryngoscope 120(1):139–143. doi:10.1002/lary.20669

    PubMed  Google Scholar 

  • Rybak LP, Whitworth CA (2005) Ototoxicity: therapeutic opportunities. Drug Discov Today 10(19):1313–1321. doi:10.1016/S1359-6446(05)03552-X

    Article  CAS  PubMed  Google Scholar 

  • Schell MJ, McHaney VA, Green AA, Kun LE, Hayes FA, Horowitz M, Meyer WH (1989) Hearing loss in children and young adults receiving cisplatin with or without prior cranial irradiation. J Clin Oncol 7(6):754–760

    Article  CAS  PubMed  Google Scholar 

  • Schmidt CM, Bartholomaus E, Deuster D, Heinecke A, Dinnesen AG (2007) The “Muenster classification” of high frequency hearing loss following cisplatin chemotherapy. HNO 55(4):299–306. doi:10.1007/s00106-005-1368-1

    Article  PubMed  Google Scholar 

  • Schuknecht HF, Karmody CS (1966) Radionecrosis of the temporal bone. Laryngoscope 76(8):1416–1428. doi:10.1288/00005537-196608000-00010

    Article  CAS  PubMed  Google Scholar 

  • Soh JM, D’Souza VD, Sarepaka GK, Ng WN, Ong CS, Low WK (2012) Cochlear implant outcomes: a comparison between irradiated and non-irradiated ears. Clin Exp Otorhinolaryngol 5(Suppl 1):S93–S98. doi:10.3342/ceo.2012.5.S1.S93

    Article  PubMed  PubMed Central  Google Scholar 

  • Talmi YP, Finkelstein Y, Zohar Y (1989) Postirradiation hearing loss. Audiology 28(3):121–126

    Article  CAS  PubMed  Google Scholar 

  • Thibadoux GM, Pereira WV, Hodges JM, Aur RJ (1980) Effects of cranial radiation on hearing in children with acute lymphocytic leukemia. J Pediatr 96(3 Pt 1):403–406

    Article  CAS  PubMed  Google Scholar 

  • Torkos A, Jori J, Toth F, Szamoskozi A, Kiss JG, Czigner J (2002) Successful cochlear implantation in a child after recovery from a head and neck malignancy: a case report. Eur Arch Otorhinolaryngol 259(7):343–346. doi:10.1007/s00405-002-0474-x

    PubMed  Google Scholar 

  • Treskes M, Nijtmans L, Fichtinger-Schepman AM, van der Vijgh WJ (1992) Cytostatic activity of cisplatin in the presence of WR2721 and its thiol metabolite WR1065 in OVCAR-3 human ovarian cancer cells as compared to V79 fibroblasts. Anticancer Res 12(6B):2261–2265

    CAS  PubMed  Google Scholar 

  • Walker DA, Pillow J, Waters KD, Keir E (1989) Enhanced cis-platinum ototoxicity in children with brain tumours who have received simultaneous or prior cranial irradiation. Med Pediatr Oncol 17(1):48–52

    Article  CAS  PubMed  Google Scholar 

  • Wang SZ, Wang WF, Zhang HY, Guo M, Hoffman MR, Jiang JJ (2007) Analysis of anatomical factors controlling the morbidity of radiation-induced otitis media with effusion. Radiother Oncol 85(3):463–468. doi:10.1016/j.radonc.2007.10.007

    Article  PubMed  Google Scholar 

  • Wang SZ, Li J, Miyamoto CT, Chen F, Zhou LF, Zhang HY, Yang G, Wang WF, Guo M, Ni XC, Wang L (2009) A study of middle ear function in the treatment of nasopharyngeal carcinoma with IMRT technique. Radiother Oncol 93(3):530–533. doi:10.1016/j.radonc.2009.09.013

    Article  PubMed  Google Scholar 

  • Williams GB, Kun LE, Thompson JW, Gould HJ, Stocks RM (2005) Hearing loss as a late complication of radiotherapy in children with brain tumors. Ann Otol Rhinol Laryngol 114(4):328–331

    Article  PubMed  Google Scholar 

  • Winther FO (1969) X-ray irradiation of the inner ear of the guinea pig. Early degenerative changes in the cochlea. Acta Otolaryngol 68(1):98–117

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paul W. Gidley M.D., F.A.C.S. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gidley, P.W. (2018). Hearing. In: Mahajan, A., Paulino, A. (eds) Radiation Oncology for Pediatric CNS Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-55430-3_33

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55430-3_33

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55428-0

  • Online ISBN: 978-3-319-55430-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics