Abstract

<h3>Purpose/Objective(s)</h3> To determine the prevalence of vertigo as a late effect of radiation therapy (RT) for head and neck cancer (HNC) and assess for a dose-volume relationship between radiation exposure to the vestibulocochlear apparatus and vertigo. We also sought to determine the impact of vertigo on functional outcomes. <h3>Materials/Methods</h3> This cross-sectional study enrolled participants treated with RT for HNC who survived at least 2 years and were free from disease at the time of enrollment. Participants completed the Short Form 36 as well as a detailed health survey with questions regarding medical history, medications, physical and mental symptoms, and socioeconomic status. Vertigo was assessed by the question "Has a doctor or other health care professional told you that you have or have had persistent dizziness or vertigo?" Mean radiation doses to the bilateral vestibulocochlear apparatuses were obtained by review of treatment plans. Differences in frequencies between groups were assessed with the chi-square test. Multiple logistic regression was used to assess the association between vertigo and physical health impairment as well as the association between vestibulocochlear dose and vertigo in models that also controlled for age and sex. <h3>Results</h3> A total of 123 HNC survivors met the inclusion criteria and had complete survey results for review. The median age of the cohort was 63.8y (range: 28.6y – 86.4y) and the median time from RT to survey completion was 4.0y (range: 2y – 28.9y); 31 (25.2%) were female and 92 (74.8%) were male. Vertigo was reported by 22 (17.9%) participants, hearing loss by 23 (18.7%), and tinnitus by 19 (15.4%). Hearing loss was present in 5 (22.7%) of patients who reported vertigo and 18 (17.8%) who did not report vertigo (p=0.593). The mean dose in Gy to the cochlea receiving the greater radiation dose was statistically associated with patient-reported vertigo (OR=1.031 95% CI: 1.001 – 1.061). Patients who reported vertigo were more likely to indicate that their physical health interfered with work activities on the SF36 (OR=4.224 95% CI: 1.567 – 11.384) whereas hearing loss was not statistically associated with interference due to physical health (OR=1.902 95% CI: 0.701 – 5.162). <h3>Conclusion</h3> Vertigo is a relatively common late adverse effect of RT for HNC that was associated with the presence of tinnitus but not hearing loss in this cohort. Radiation exposure to the vestibulocochlear apparatus was associated with the development of vertigo, and patients who developed vertigo were more likely to report that their physical health interfered with work activities. The results of this study highlight an ongoing need to study the late effects among HNC survivors. Future work is needed to characterize associations between vertigo and chemotherapy and other modifiable treatment factors.

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