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: 4.26). 03/2010; 76(3 Suppl):S50-7. DOI: 10.1016/j.ijrobp.2009.04.096
Source: PubMed


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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Available from: John C Flickinger, Sep 29, 2015
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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.
    Radiotherapy and Oncology 09/2014; 112(3). DOI:10.1016/j.radonc.2014.08.028 · 4.36 Impact Factor
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    • "This is associated with psychological and cognitive morbidity [32]. The mean dose to the cochlea should be limited to ≤45Gy (or more conservatively ≤35Gy); and when combined with cisplatin, strictly limited [33]. "
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    ABSTRACT: Background The accurate definition of organs at risk (OARs) is required to fully exploit the benefits of intensity-modulated radiotherapy (IMRT) for head and neck cancer. However, manual delineation is time-consuming and there is considerable inter-observer variability. This is pertinent as function-sparing and adaptive IMRT have increased the number and frequency of delineation of OARs. We evaluated accuracy and potential time-saving of Smart Probabilistic Image Contouring Engine (SPICE) automatic segmentation to define OARs for salivary-, swallowing- and cochlea-sparing IMRT. Methods Five clinicians recorded the time to delineate five organs at risk (parotid glands, submandibular glands, larynx, pharyngeal constrictor muscles and cochleae) for each of 10 CT scans. SPICE was then used to define these structures. The acceptability of SPICE contours was initially determined by visual inspection and the total time to modify them recorded per scan. The Simultaneous Truth and Performance Level Estimation (STAPLE) algorithm created a reference standard from all clinician contours. Clinician, SPICE and modified contours were compared against STAPLE by the Dice similarity coefficient (DSC) and mean/maximum distance to agreement (DTA). Results For all investigated structures, SPICE contours were less accurate than manual contours. However, for parotid/submandibular glands they were acceptable (median DSC: 0.79/0.80; mean, maximum DTA: 1.5 mm, 14.8 mm/0.6 mm, 5.7 mm). Modified SPICE contours were also less accurate than manual contours. The utilisation of SPICE did not result in time-saving/improve efficiency. Conclusions Improvements in accuracy of automatic segmentation for head and neck OARs would be worthwhile and are required before its routine clinical implementation.
    Radiation Oncology 08/2014; 9(1):173. DOI:10.1186/1748-717X-9-173 · 2.55 Impact Factor
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    • "It has been observed that hearing acuity is either not affected or only minimally decreased in children treated only by RT [14,15]. As a matter of fact, doses to the inner ear less than 40 Gy hardly ever causes ototoxicity [11,14-16], however the threshold dose for NSHL with cisplatin-based chemotherapy and RT can be as low as 10 Gy [16-18]. Likewise, children with CNS shunting have increased risk to develop NSHL and the mean RT dose to the ear should to be limited in 45 Gy or even conservatively below 36 Gy, mainly when combined to cisplatin chemotherapy [11]. "
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    ABSTRACT: Background: Ototoxicity is a known side effect of combined radiation therapy and cisplatin chemotherapy for the treatment of medulloblastoma. The delivery of an involved field boost by intensity modulated radiation therapy (IMRT) may reduce the dose to the inner ear when compared with conventional radiotherapy. The dose of cisplatin may also affect the risk of ototoxicity. A retrospective study was performed to evaluate the impact of involved field boost using IMRT and cisplatin dose on the rate of ototoxicity. Methods: Data from 41 medulloblastoma patients treated with IMRT were collected. Overall and disease-free survival rates were calculated by Kaplan-Meier method Hearing function was graded according to toxicity criteria of Pediatric Oncology Group (POG). Doses to inner ear and total cisplatin dose were correlated with hearing function by univariate and multivariate data analysis. Results: After a mean follow-up of 44 months (range: 14 to 72 months), 37 patients remained alive, with two recurrences, both in spine with CSF involvement, resulting in a disease free-survival and overall survival of 85.2% and 90.2%, respectively.Seven patients (17%) experienced POG Grade 3 or 4 toxicity. Cisplatin dose was a significant factor for hearing loss in univariate analysis (p < 0.03). In multivariate analysis, median dose to inner ear was significantly associated with hearing loss (p < 0.01). POG grade 3 and 4 toxicity were uncommon with median doses to the inner ear bellow 42 Gy (p < 0.05) and total cisplatin dose of less than 375 mg/m2 (p < 0.01). Conclusions: IMRT leads to a low rate of severe ototoxicity. Median radiation dose to auditory apparatus should be kept below 42 Gy. Cisplatin doses should not exceed 375 mg/m2.
    Radiation Oncology 07/2014; 9(1):158. DOI:10.1186/1748-717X-9-158 · 2.55 Impact Factor
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