Ototoxicity after intensity-modulated radiation therapy and cisplatin-based chemotherapy in children with medulloblastoma.
OBJECTIVE
To report the incidence of Pediatric Oncology Group (POG) Grade 3 or 4 ototoxicity in a cohort of patients treated with craniospinal irradiation (CSI) followed by posterior fossa (PF) and/or tumor bed (TB) boost using intensity-modulated radiation therapy (IMRT).


METHODS
From 1998 to 2006, 44 patients with medulloblastoma were treated with CSI followed by IMRT to the PF and/or TB and cisplatin-based chemotherapy. Patients with standard-risk disease were treated with 18 to 23.4 Gy CSI followed by either a (1) PF boost to 36 Gy and TB boost to 54 to 55.8 Gy or (2) TB boost to 55.8 Gy. Patients with high-risk disease received 36 to 39.6 Gy CSI followed by a (1) PF boost to 54 to 55.8 Gy, (2) PF boost to 45 Gy and TB boost to 55.8 Gy, or (3) TB boost to 55.8 Gy. Median audiogram follow-up was 41 months (range, 11-92.4 months).


RESULTS
POG Grade Ototoxicity 0, 1, 2, 3. and 4 was found in 29, 32, 11, 13. and 3 ears. respectively, with POG Grade 3 or 4 accounting for 18.2% of cases. There was a statistically significant difference in mean radiation dose (D(mean)) cochlea according to degree of ototoxicity, with D(mean) cochlea increasing with severity of hearing loss (p = 0.027).


CONCLUSIONS
Severe ototoxicity was seen in 18.2% of ears in children treated with IMRT boost and cisplatin-based chemotherapy. Increasing dose to the cochlea was associated with increasing severity of hearing loss.
Paulino
Arnold C
AC
Department of Radiation Oncology, The Methodist Hospital and The Methodist Hospital Research Institute, Houston, TX 77030, USA. apaulino@tmhs.org
Lobo
Mark
M
Teh
Bin S
BS
Okcu
M Fatih
MF
South
Michael
M
Butler
E Brian
EB
Su
Jack
J
Chintagumpala
Murali
M
D000293:Adolescent; D004999:Amifostine / Q000008:administration & dosage; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D002528:Cerebellar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003051:Cochlea / Q000187:drug effects / Q000528:radiation effects; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects; D005260:Female; D034381:Hearing Loss / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000532:radiotherapy; D058958:Organs at Risk / Q000528:radiation effects; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies
D004999:Amifostine; D002945:Cisplatin