Abstract
BackgroundHearing 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.MethodsFrom 2006-2009, 23 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.ResultsThe predicted mean cochlear radiation dose was 30 60Co-Gy Equivalents (range 19-43), and the mean cumulative cisplatin dose was 303 mg/m2 (range 298-330). Hearing sensitivity significantly declined following radiotherapy across all frequencies analyzed (P < 0.05). There was partial sparing of mean post-radiation hearing thresholds at low-to-midrange frequencies and, consequently, the rate of high-grade (grade 3 or 4) ototoxicity at 1 year was favorable (5%). Ototoxicity did not correlate with predicted dose to the auditory apparatus for proton-treated patients, potentially reflecting a lower-limit threshold for radiation effect on the cochlea.ConclusionsRates of high-grade early post-radiation ototoxicity following proton radiotherapy for pediatric medulloblastoma are low. Preservation of hearing in the audible speech range, as observed here, may improve both quality of life and cognitive functioning for these patients.
Highlights
Hearing loss is common following chemoradiotherapy for children with medulloblastoma
Ototoxicity is typically considered to be a late effect of radiotherapy, with a latency of approximately four years [14,15], radiation potentiates early cisplatin-induced ototoxicity when the two are delivered concomitantly [6,7], an effect typically peaking within a year of treatment [8]
The objective of this study is to determine whether proton radiotherapy technique spares drugs were in use by any patient at the time they were this early ototoxicity for children with medulloblastoma. simulated for radiotherapy
Summary
Hearing loss is common following chemoradiotherapy for children with medulloblastoma. Hearing loss is an important consequence of therapy for children with intracranial malignancies, including medulloblastoma [1,2]. It can have a profound impact on a child’s quality of life, affecting communication skills and social and cognitive development [3,4,5]. Efforts to mitigate treatment-related ototoxicity for these patients tumors have included the use of conformal radiotherapy techniques to minimize radiation dose. The objective of this study is to determine whether proton radiotherapy technique spares drugs were in use by any patient at the time they were this early ototoxicity for children with medulloblastoma. The objective of this study is to determine whether proton radiotherapy technique spares drugs were in use by any patient at the time they were this early ototoxicity for children with medulloblastoma. simulated for radiotherapy
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