Assessment of Hearing Ability in Patients after Head and Neck Cancer Radiotherapy

Document Type : Original Paper

Authors

1 Students Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

2 Students Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

3 Department of Radiation Oncology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

4 Associate Professor in Medical Physics, Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

10.22038/ijmp.2024.78841.2395

Abstract

Introduction: The study assesses radiation-induced sensorineural hearing loss (SNHL) in head and neck cancer patients, highlighting the common occurrence of SNHL as a significant side effect of radiation therapy (RT) targeting the cochlea and acoustic pathways.
Material and Methods: The study included 34 patients (22 men, 12 women, mean age 40.13 ± 26.8 years) with head and neck cancers undergoing three-dimensional conformal radiation therapy (3D-CRT); 16 also had chemoradiotherapy (CRT). Pure-tone audiometry (PTA: 250-8000 Hz) was done before, immediately after, and three months post-RT for all patients. Hearing impairment was evaluated using the CTCAE 4.03 scoring system.
Results: According to the findings, 19% and 37% of ears experienced SNHL immediately post-RT and 3 months after RT, respectively. The mean cochlear dose was 25.48 ± 13.56 Gy. A significant correlation existed between the cochlear dose and SNHL incidence (P-value < 0.05). Regression analysis indicated the mean cochlear dose as a robust predictor of SNHL, particularly at 8000 Hz (β = 0.570, P-value = 0.0001). Highest SNHL incidence at 8000 Hz, 3 months post-RT. A significant difference in SNHL threshold was observed between men and women at the frequency of 1000 Hz (P-value = 0.024). There was a statistically significant difference in SNHL thresholds between patients who underwent CRT versus those treated with RT alone (P-value < 0.05).
Conclusion: RT commonly causes SNHL in head and neck cancer patients. Mean cochlear dose predicts SNHL, especially at higher frequencies.

Keywords

Main Subjects

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA: a cancer journal for clinicians. 2021 Jan;71(1):7-33.
  2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2021 May;71(3):209-49.
  3. Sullivan CB, Al‐Qurayshi Z, Anderson CM, Seaman AT, Pagedar NA. Factors associated with the choice of radiation therapy treatment facility in head and neck cancer. The Laryngoscope. 2021 May;131(5):1019-25.
  4. Keyghobadi N, Rafiemanesh H, Mohammadian-Hafshejani A, Enayatrad M, Salehiniya H. Epidemiology and trend of cancers in the province of Kerman: southeast of Iran. Asian Pacific Journal of Cancer Prevention. 2015;16(4):1409-13.
  5. Shukla M, Forghani R, Agarwal M. Patient-Centric Head and Neck Cancer Radiation Therapy: Role of Advanced Imaging. Neuroimaging Clinics. 2020 Aug 1;30(3):341-57.
  6. Alfouzan AF. Radiation therapy in head and neck cancer. Saudi medical journal. 2021 Mar;42(3):247.
  7. Koudougou C, Bertin H, Lecaplain B, Badran Z, Longis J, Corre P, et al. Postimplantation radiation therapy in head and neck cancer patients: Literature review. Head & neck. 2020 Apr;42(4):794-802.
  8. Asif M, Moore A, Yarom N, Popovtzer A. The effect of radiotherapy on taste sensation in head and neck cancer patients–a prospective study. Radiation Oncology. 2020 Dec;15:1-9.
  9. Borras JM, Barton M, Grau C, Corral J, Verhoeven R, Lemmens V, et al. The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project. Radiotherapy and Oncology. 2015 Jul 1;116(1):45-50.
  10. Wicker CA, Petery T, Dubey P, Wise-Draper TM, Takiar V. Improving radiotherapy response in the treatment of head and neck cancer. Critical Reviews™ in Oncogenesis. 2022;27(2).
  11. Landier W. Ototoxicity and cancer therapy. Cancer. 2016 Jun 1;122(11):1647-58.
  12. Huang Y, Zhou H, An F, Zhao A, Wu J, Wang M, et al. The relevance of ototoxicity induced by radiotherapy. Radiation Oncology. 2023 Jun 3;18(1):95.
  13. Bass JK, Hua CH, Huang J, Onar-Thomas A, Ness KK, Jones S, et al. Hearing loss in patients who received cranial radiation therapy for childhood cancer. Journal of Clinical Oncology. 2016 Apr 10;34(11):1248-55.
  14. Nanda S, Parida S, Ahirwar MK. A Dosimetric Comparison of Volumetric-modulated Arc Therapy and IMRT for Cochlea-sparing Radiation Therapy in Locally Advanced Nasopharyngeal Cancer. Journal of Medical Physics. 2023 Jul 1;48(3):248-51.
  15. Hasegawa T, Kida Y, Kato T, Iizuka H, Yamamoto T. Factors associated with hearing preservation after Gamma Knife surgery for vestibular schwannomas in patients who retain serviceable hearing. Journal of neurosurgery. 2011 Dec 1;115(6):1078-86.
  16. Shi W, Hou X, Bao X, Hou W, Jiang X, Ma L, et al. Mechanism and protection of radiotherapy induced sensorineural hearing loss for head and neck cancer. BioMed Research International. 2021;2021(1):3548706.
  17. Lamaj E, Vu E, van Timmeren JE, Leonardi C, Marc L, Pytko I, et al. Cochlea sparing optimized radiotherapy for nasopharyngeal carcinoma. Radiation Oncology. 2021 Dec;16:1-2.
  18. Emami B. Tolerance of normal tissue to therapeutic radiation. Reports of radiotherapy and Oncology. 2013 Jun 1;1(1):123-7.
  19. Bhandare N, Jackson A, Eisbruch A, Pan CC, Flickinger JC, Antonelli P, et al. Radiation therapy and hearing loss. International Journal of Radiation Oncology* Biology* Physics. 2010 Mar 1;76(3):S50-7.
  20. Deutsch BC, Collopy C, Kallogjeri D, Piccirillo JF. Validation of hearing loss prediction tool for cisplatin chemotherapy and radiation in head and neck cancer treatment. JAMA Otolaryngology–Head & Neck Surgery. 2021 Feb 1;147(2):182-9.
  21. Schuette A, Lander DP, Kallogjeri D, Collopy C, Goddu S, Wildes TM, Daly M, Piccirillo JF. Predicting hearing loss after radiotherapy and cisplatin chemotherapy in patients with head and neck cancer. JAMA Otolaryngology–Head & Neck Surgery. 2020 Feb 1;146(2):106-12.
  22. Colevas AD, Lira RR, Colevas EA, Lavori PW, Chan C, Shultz DB, et al. Hearing evaluation of patients with head and neck cancer: Comparison of Common Terminology Criteria for Adverse Events, Brock and Chang adverse event criteria in patients receiving cisplatin. Head & neck. 2015 Aug;37(8):1102-7.
  23. Ejaz A, Greenberger JS, Rubin PJ. Understanding the mechanism of radiation induced fibrosis and therapy options. Pharmacology & therapeutics. 2019 Dec 1;204:107399.
  24. Mujica–Mota M, Waissbluth S, Daniel SJ. Characteristics of radiation‐induced sensorineural hearing loss in head and neck cancer: A systematic review. Head & neck. 2013 Nov;35(11):1662-8.
  25. Theunissen EA, Bosma SC, Zuur CL, Spijker R, van der Baan S, Dreschler WA, et al. Sensorineural hearing loss in patients with head and neck cancer after chemoradiotherapy and radiotherapy: a systematic review of the literature. Head & neck. 2015 Feb;37(2):281-92.
  26. Schultz C, Goffi-Gomez MV, Liberman PH, de Assis Pellizzon AC, Carvalho AL. Hearing loss and complaint in patients with head and neck cancer treated with radiotherapy. Archives of Otolaryngology–Head & Neck Surgery. 2010 Nov 15;136(11):1065-9.
  27. Bachtiary B, Veraguth D, Roos N, Pfiffner F, Leiser D, Pica A, et al. Hearing loss in cancer patients with skull base tumors undergoing pencil beam scanning proton therapy: a retrospective cohort study. Cancers. 2022 Aug 9;14(16):3853.
  28. Saluja M, Thakur J, Azad R, Sharma D, Mohindroo N, Seam R, Vasanthalakshmi M. Radiotherapy induced hearing loss in head neck cancers: screening with DPOAE. Head Neck Oncol. 2014;6(3):3.
  29. Das N, Kaushal D, Patro SK, Pareek P, Dixit A, Soni K, et al. Relative contributions of radiation and cisplatin-based chemotherapy to sensorineural hearing loss in head-and-neck cancer patients. Acta Oto-Laryngologica. 2021 Sep 1;141(9):885-93.
  30. Malgonde MS, Nagpure PS, Kumar M. Audiometric patterns in ototoxicity after radiotherapy and chemotherapy in patients of head and neck cancers. Indian journal of palliative care. 2015 May;21(2):164.
  31. Cheraghi S, Nikoofar P, Fadavi P, Bakhshandeh M, Khoie S, Gharehbagh EJ, et al. Short-term cohort study on sensorineural hearing changes in head and neck radiotherapy. Medical Oncology. 2015 Jul;32:1-7.
  32. Hwang CF, Fang FM, Zhuo MY, Yang CH, Yang LN, Hsieh HS. Hearing assessment after treatment of nasopharyngeal carcinoma with CRT and IMRT techniques. BioMed Research International. 2015;2015(1):769806.
  33. Mosleh-Shirazi MA, Amraee A, Mohaghegh F. Dose-response relationship and normal-tissue complication probability of conductive hearing loss in patients undergoing head-and-neck or cranial radiotherapy: a prospective study including 70 ears. Physica Medica. 2019 May 1;61:64-9.
  34. Patel KS, Ng E, Kaur T, Miao T, Kaprealian T, Lee P, et al. Increased cochlear radiation dose predicts delayed hearing loss following both stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannoma. Journal of neuro-oncology. 2019 Nov;145:329-37.
  35. Nutting CM, Morden JP, Beasley M, Bhide S, Cook A, De Winton E, et al. Results of a multicentre randomised controlled trial of cochlear-sparing intensity-modulated radiotherapy versus conventional radiotherapy in patients with parotid cancer (COSTAR; CRUK/08/004). European Journal of Cancer. 2018 Nov 1;103:249-58.
  36. Zhang C, Liu LX, Li WZ, Liang W, Chen ZH, Huang XH, et al. Cochlea sparing with a stratified scheme of dose limitation employed in intensity-modulated radiotherapy for nasopharyngeal carcinoma: A dosimetry study. Medical Dosimetry. 2019 Sep 1;44(3):226-32.
  37. Wang J, Chen YY, Tai A, Chen XL, Huang SM, Yang C, et al. Sensorineural hearing loss after combined intensity modulated radiation therapy and cisplatin-based chemotherapy for nasopharyngeal carcinoma. Translational oncology. 2015 Dec 1;8(6):456-62.
  38. Pandav R, Yadav V, Bhagat S, Sharma DK. Ototoxicity in Patients of Advanced Head and Neck Malignancies Receiving Chemoradiation Versus Radiation Alone: Comparative Study. Indian Journal of Otolaryngology and Head & Neck Surgery. 2022 Dec;74(Suppl 3):3927-32.

 

Iranian Journal of Medical Physics
Volume 21, Issue 5 - Serial Number 5
September and October 2024
Pages 336-342

Files

History

  • Receive Date: 19 March 2024
  • Revise Date: 23 May 2024
  • Accept Date: 27 May 2024

Share

How to cite

Statistics