Risk factors of ototoxicity after cisplatin-based chemo-irradiation in patients with locally advanced head-and-neck cancer: a multivariate analysis.

Abstract

PURPOSE:

Cisplatin chemo-irradiation is increasingly used in locally advanced squamous cell carcinoma of the head and neck. The objective of this study is to determine risk factors of ototoxicity due to intra-arterial high-dose cisplatin chemoradiation.

METHODS AND MATERIALS:

A prospective analysis of hearing thresholds at low and (ultra) high frequencies obtained before, during, and after treatment in 146 patients. Treatment consisted of intra-arterial infusion of high-dose cisplatin (150 mg/m(2), four courses) with sodium thiosulfate rescue and concurrent radiation therapy (70 Gy). Patient and chemoradiation variables were studied in a multivariate analysis.

RESULTS:

After treatment, 23% of the ears were under consideration for hearing aids because of therapy. Twenty-two percent of the patients developed an increase in air-bone gap >10 dB during or after therapy. In the multivariate explanatory analysis, cumulative dose of cisplatin and radiation therapy, and young age displayed a causal relationship with increased sensorineural hearing loss during and after therapy (p < 0.001). In the multivariate prediction analysis, pretreatment hearing level of the concerning ear was identified as an independent predictive factor for hearing capability after therapy (p < 0.0001).

CONCLUSIONS:

Both cisplatin and radiation therapy were proven to induce sensorineural hearing loss, in this study with short-term follow-up. Of all patient and treatment variables studied, the patients pretreatment hearing level appeared to be the main predictive factor for hearing capability after high-dose intra-arterial cisplatin chemoradiation.

• Authors: Charlotte L Zuur, Yvonne J Simis, Pauline E Lansdaal, Augustinus A Hart, Coen R Rasch, Jan H Schornagel, Wouter A Dreschler, Alfons J Balm
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 68 Issue 5 Pg. 1320-5 (Aug 01 2007) ISSN: 0360-3016 [Print] United States
• PMID: 17418969 (Publication Type: Journal Article)

Chemical References

• Antidotes
• Antineoplastic Agents
• Thiosulfates
• sodium thiosulfate
• Cisplatin

Topics

• Age Factors
• Antidotes (therapeutic use)
• Antineoplastic Agents (administration & dosage, adverse effects)
• Carcinoma, Squamous Cell (drug therapy, radiotherapy, therapy)
• Cisplatin (administration & dosage, adverse effects)
• Combined Modality Therapy (methods)
• Female
• Head and Neck Neoplasms (drug therapy, radiotherapy, therapy)
• Hearing (drug effects, radiation effects)
• Hearing Loss, Sensorineural (chemically induced, etiology)
• Humans
• Infusions, Intra-Arterial
• Male
• Middle Aged
• Multivariate Analysis
• Prospective Studies
• Radiation Dosage
• Risk Factors
• Thiosulfates (therapeutic use)