Prediction of Hearing Loss Due to Cisplatin Chemoradiotherapy.
OBJECTIVE
Patients with head and neck cancer may experience chemoradiotherapy-induced hearing loss, but the weighing of involved variables has been subjective. Identification of patient and treatment characteristics to predict the absolute posttreatment hearing level is important for effective counseling of patients undergoing chemoradiotherapy.


OBJECTIVE
To predict treatment-induced hearing loss among patients with head and neck cancer.


METHODS
A retrospective cohort study was performed at The Netherlands Cancer Institute. One hundred and fifty-six patients with head and neck cancer treated with concomitant chemoradiotherapy as the primary treatment modality from January 1, 1997, through December 31, 2011, were enrolled. Follow-up was complete on March 1, 2012, and data were analyzed from April 1, 2011, through November 5, 2013.


METHODS
High-dose intravenously administered cisplatin-based concomitant chemoradiotherapy. Cisplatin, 100 mg/m2, was administered in 3 courses on days 1, 22, and 43 during 7 weeks of radiotherapy (total radiation dose, 70 Gy in 35 fractions).


METHODS
Posttreatment bone conduction hearing threshold at pure-tone average frequencies of 1, 2, and 4 kHz, based on pure-tone audiometry after completion of treatment. Predictors included baseline hearing levels, radiation dose to the cochlea, and cisplatin dose. A multilevel mixed-effects linear regression model for predicting whether or not posttreatment hearing was at least 35 dB was established, and cross-validated sensitivity and specificity were obtained.


RESULTS
Of 156 patients who received high-dose concomitant chemoradiotherapy, 15 were missing the exact radiation dose to the cochlea and 41 had no data on posttreatment pure-tone audiometry. Nineteen patients had a hearing level of at least 35 dB for at least 1 ear before the treatment. The remaining 81 patients (162 ears) had a total cumulative cisplatin dose ranging from 315 to 600 (median, 546) mg. The radiation dose to the cochlea ranged from 1.1 to 70.9 (median, 13.6) Gy. Based on data from the 81 patients (162 ears), the area under the receiver operating characteristic curve was 0.68, with a sensitivity of 29% (95% CI, 13%-51%) and a specificity of 97% (95% CI, 88%-100%), resulting in a positive predictive value of 78%.


CONCLUSIONS
Patient and treatment characteristics can be used to predict hearing level after concomitant chemoradiotherapy for head and neck cancer. This step may constitute the first in evidence-based individual counseling for treatment-induced hearing loss.
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands2Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Eleonoor A R
EA
Theunissen
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands3Department of Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Charlotte L
CL
Zuur
Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Katarzyna
K
Józwiak
Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Marta
M
Lopez-Yurda
Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Michael
M
Hauptmann
Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Coen R N
CR
Rasch
Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Sieberen
S
van der Baan
Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Jan Paul
JP
de Boer
Division of Audiology, Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Wouter A
WA
Dreschler
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands3Department of Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Alfons J M
AJ
Balm
D001301:Audiometry, Pure-Tone; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects*; D003051:Cochlea / Q000187:drug effects / Q000528:radiation effects; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003638:Deafness / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007262:Infusions, Intravenous; D009367:Neoplasm Staging; D010039:Otorhinolaryngologic Neoplasms / Q000473:pathology / Q000628:therapy*; D010353:Patient Education as Topic; D011829:Radiation Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors
D002945:Cisplatin