title: [Ototoxicity in head and neck cancers after radiotherapy and chemoradiotherapy: From primary prevention to tertiary prevention].
abstract: Each year, 15,000 head and neck cancer are treated in France. Prognosis is steadily improving. Consequently, limitation of late toxicities becomes essential. Ototoxicity is common, disabling and undervalued. We aimed to inventory primary, secondary and tertiary prevention measures to reduce ototoxicity induced by radiotherapy and chemotherapy, as well as its impact on quality of life of patients treated for head and neck cancer. External radiation therapy induced 30 to 40% of ototoxicity, including irreversible sensorineural hearing loss. Primary prevention of this risk is based on limiting the dose to the cochlea: 40Gy in case of radiotherapy alone, 10Gy during concomitant chemoradiotherapy with cisplatin. Dose gradients allowed by intensity-modulated radiotherapy help respecting these limits. Concurrent chemotherapy with high dose cisplatin (100mg/m2) also causes hearing loss by cochlear damages. Prescription of carboplatin-5-fluorouracil combination or cetuximab should be preferred in case of high risk of ototoxicity. This risk must be precisely evaluated before treatment. Ototoxicity monitoring during treatment allows early management, and lower long-term impact. Radiosensitivity predictive tests and research of genetic factors predisposing to chemo-induced ototoxicity should enable optimization of therapeutic choices and monitoring.
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Espenel
authors.affiliation: Département de santé publique, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Garcia
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: J-B
authors.initials: JB
authors.lastname: Guy
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Vallard
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Ben Mrad
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Langrand-Escure
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: El Meddeb Hamrouni
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Trone
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Xia
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Rancoule
authors.affiliation: Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez cedex, France. Electronic address: nicolas.magne@icloire.fr.
authors.forename: N
authors.initials: N
authors.lastname: Magné
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003051:Cochlea / Q000187:drug effects / Q000528:radiation effects; D003131:Combined Modality Therapy; D004433:Earache / Q000139:chemically induced / Q000209:etiology; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D006314:Hearing Loss, Conductive / Q000209:etiology / Q000517:prevention & control*; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D058958:Organs at Risk; D010031:Otitis / Q000139:chemically induced / Q000209:etiology; D011322:Primary Prevention / Q000379:methods; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D011836:Radiation Tolerance; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D055502:Secondary Prevention / Q000379:methods; D055512:Tertiary Prevention / Q000379:methods
chemical_list: D002945:Cisplatin
keywords: Cancers ORL; Chemotherapy; Chimiothérapie; Head and neck cancers; Ototoxicity; Ototoxicité; Radiotherapy; Radiothérapie