Radiation Therapy and Hearing Loss

Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610, USA.
International journal of radiation oncology, biology, physics (Impact Factor: 4.18). 03/2010; 76(3 Suppl):S50-7. DOI: 10.1016/j.ijrobp.2009.04.096
Source: PubMed

ABSTRACT A review of literature on the development of sensorineural hearing loss after high-dose radiation therapy for head-and-neck tumors and stereotactic radiosurgery or fractionated stereotactic radiotherapy for the treatment of vestibular schwannoma is presented. Because of the small volume of the cochlea a dose-volume analysis is not feasible. Instead, the current literature on the effect of the mean dose received by the cochlea and other treatment- and patient-related factors on outcome are evaluated. Based on the data, a specific threshold dose to cochlea for sensorineural hearing loss cannot be determined; therefore, dose-prescription limits are suggested. A standard for evaluating radiation therapy-associated ototoxicity as well as a detailed approach for scoring toxicity is presented.

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    • "As Voet et al. conducted an analysis using AS to define nodal target volumes as well as OARs which were then used unedited for planning [23], resulting in under dosage of target volumes, we are as yet conceptually unwilling to accept unmodified AS-defined GTV/ CTV ROIs, including elective neck contours generated as AS-contoured nodal basins. Our data suggest clinically unacceptable AS segmentation for several critical OAR structures (e.g., chiasm, cochlea, and larynx), inadvertent overdosage of which might result in blindness [24], hearing loss [25], or aspiration/dysphagia [26]. Additionally, it must be carefully stressed that the criticality of ROI segmentation remains, at its most fundamental, the primary driver of subsequent planning. "
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    ABSTRACT: Background and purpose: Target volumes and organs-at-risk (OARs) for radiotherapy (RT) planning are manually defined, which is a tedious and inaccurate process. We sought to assess the feasibility, time reduction, and acceptability of an atlas-based autosegmentation (AS) compared to manual segmentation (MS) of OARs. Materials and methods: A commercial platform generated 16 OARs. Resident physicians were randomly assigned to modify AS OAR (AS + R) or to draw MS OAR followed by attending physician correction. Dice similarity coefficient (DSC) was used to measure overlap between groups compared with attending approved OARs (DSC = 1 means perfect overlap). 40 cases were segmented. Results: Mean +/- SD segmentation time in the AS + R group was 19.7 +/- 8.0 min, compared to 28.5 +/- 8.0 min in the MS cohort, amounting to a 30.9% time reduction (Wilcoxon p < 0.01). For each OAR, AS DSC was statistically different from both AS + R and MS ROIs (all Steel-Dwass p < 0.01) except the spinal cord and the mandible, suggesting oversight of AS/MS processes is required; AS + R and MS DSCs were non-different. AS compared to attending approved OAR DSCs varied considerably, with a chiasm mean +/- SD DSC of 0.37 +/- 0.32 and brainstem of 0.97 +/- 0.03. Conclusions: Autosegmentation provides a time savings in head and neck regions of interest generation. However, attending physician approval remains vital. (C) 2014 Elsevier Ireland Ltd.
    Radiotherapy and Oncology 09/2014; 112(3). DOI:10.1016/j.radonc.2014.08.028 · 4.86 Impact Factor
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    ABSTRACT: During the past decades, in small-to-medium size vestibular schwannomas, Gamma Knife surgery (GKS) has become a reliable therapeutic option because of either excellent local tumor control or minimal morbidity, with cranial neuropathy becoming increasingly rare. Although still insufficiently analyzed in larger cohorts of patients with long-term follow-ups, adequate chances of hearing preservation and vestibular sparing seem clinically guaranteed. However, deeper investigations are needed in this regard, expanding the number of cases and the follow-up period. A small group of patients with vestibular schwannomas (74 patients, including 41 men and 33 women) treated between 2003 and 2009 using GKS at the authors' institution were analyzed--both before and after GKS--with computerized static stabilometry and electronystagmography for balance disorders, vertigo, and ataxia on 1 side and pure tone average, vocal speech discrimination score, auditory brainstem response, and so forth for hearing impairment and tinnitus on the other side. Eligibility criteria for this prospective study included previously untreated unilateral lesions and a Gardner-Robertson hearing class of I-III. Dosimetry plans had been programmed at the lower effective dosages for these tumors (median surface dose 12.4 Gy, range 10-13 Gy), carefully avoiding even minimal toxic dosages on the most vulnerable targets: the cochlea (never > 6 Gy) and the vestibular canals (< 7.5 Gy). To date, tumor growth control rates remain satisfactory; at a mean follow-up of 50 months, the rate was 96%. The overall level of hearing preservation was 72%, with 81% having Gardner-Robertson Class I hearing. Tinnitus decreased, from 52% to 28% of patients (p < 0.01). Significant improvements were also observed in vestibular symptoms, with computerized static stabilometry abnormalities decreasing from 62% to 32% (p < 0.001) and electronystagmography abnormalities reducing from 48% to 14% (p < 0.001). Using appropriate radiodosimetry planning, GKS seems to guarantee not only adequate tumor growth control rates, but also better levels of hearing preservation, with a documented, long-lasting improvement in vestibular functions.
    Journal of Neurosurgery 12/2010; 113 Suppl:128-35. · 3.15 Impact Factor
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    ABSTRACT: Technological advances in the field of radiation oncology have revolutionized the management of head and neck cancer over the last decade. As will be discussed, the transition toward more technologically sophisticated methods of radiation therapy (RT) planning and delivery has presented clinicians with unanswered questions requiring a search for new standards. Given the inherent complexity of many of the radiotherapeutic techniques currently used, a thorough understanding of the strengths and weaknesses of each is imperative so that the potential for disease cure can be maximized while keeping side effects to a minimum. Thus, the goal of this chapter is for the reader to gain an understanding of these technological issues and to develop an appreciation of the “art,” as well as the “science” of RT for head and neck cancer. In this chapter, the use of RT refers to external-beam techniques utilizing high-energy photons unless otherwise stated.
    Technical Basis of Radiation Therapy, 01/2011: pages 601-640;
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