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Abu-Arja MH, Brown AL, Su JM, Okcu MF, Lindsay HB, McGovern SL, McAleer MF, Grosshans DR, Chintagumpala MM, Paulino AC. The cochlear dose and the age at radiotherapy predict severe hearing loss after passive scattering proton therapy and cisplatin in children with medulloblastoma. Neuro Oncol 2024; 26:1912-1920. [PMID: 38916058 PMCID: PMC11449093 DOI: 10.1093/neuonc/noae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Hearing loss (HL) is associated with worse neurocognitive outcomes among patients with medulloblastoma. We aimed to identify risk factors associated with severe HL and to evaluate the generalizability of a published HL calculator among patients treated with passive scattering proton therapy (PSPT) and cisplatin. METHODS We identified patients aged 3-21 years who were treated at our centers between 2007 and 2022. Audiograms were graded using the International Society of Pediatric Oncology (SIOP) Boston scale. Time to grades 3-4 HL was evaluated using Kaplan-Meier and multivariable Cox models to estimate hazard ratios and 95% confidence intervals (CI). RESULTS Seventy-nine patients were treated with PSPT at a median age of 7.5 years (range: 3.1-21.1). The mean cochlear dose (Dmc) (±SD) was 31.5 ± 8.5 Gy, and the cumulative cisplatin dose was 295 ± 50 mg/m2. Fifty-nine patients (75%) received amifostine. Patients completed a median of 9 audiograms (range: 4-22) with a median audiogram follow-up of 49 months (range: 6-177). Twenty-seven patients (34%) had grades 3-4 HL. In adjusted Cox models, only higher Dmc (HR = 1.12, 95% CI:1.06-1.18) was associated with grades 3-4 HL. The predicted 3-year incidence of grades 3-4 HL was 40.0% (95% CI: 21.3-66.3) and 66.7% (95% CI: 35.4-93.7) for children with Dmc ≥36 Gy and age at radiotherapy ≥7 and <7 years, respectively (P = .042). It was 8.9% (95% CI: 2.3-31.6) and 15.6% (95% CI: 5.3-41.1) for children with Dmc <36 Gy and age at radiotherapy ≥7 and <7 years, respectively (P = .78). CONCLUSIONS Children <7 years at radiotherapy with a Dmc ≥36 Gy are at higher risk for HL.
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Affiliation(s)
- Mohammad H Abu-Arja
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Austin L Brown
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Jack M Su
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - M Fatih Okcu
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Holly B Lindsay
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
- Center for Cancer and Blood Disorders, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David R Grosshans
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Murali M Chintagumpala
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Gehin W, Chastagner P, Mansuy L, Bernier-Chastagner V. Dosimetric analysis of hearing loss after cranial radiation therapy in children: A single-institution study from the French national registry PediaRT. Radiother Oncol 2024; 197:110346. [PMID: 38806115 DOI: 10.1016/j.radonc.2024.110346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE To identify dosimetric predictive factors of sensorineural hearing loss (SNHL) in children after cranial radiation therapy (RT) in a single institution using dosimetric data from the French National Registry PediaRT. METHODS AND MATERIALS Complete audiological follow-up data were available for 44 children treated with cranial RT between 2014 and 2021 at our institution. The median age at the time of RT initiation was 9 years (range: 2-17 years). No children presented with hearing loss prior to treatment. SNHL was defined as a Chang ototoxicity grade ≥ 1a or higher. RESULTS Median audiometric follow-up duration was 51 months. Seven children (16 %) developed SNHL with a median time to occurrence of 33 months (range, 18-46 months). The estimated SNHL cumulative rate at 2 years post-RT was 4,5% ± 3,1% and at 5 years was 21 % ± 7.2 %. Multiple Cox regression models showed that the association of the age at radiotherapy and the dosimetric values to the inner ear canal and cochlea were the most significant predictive factors of SNHL occurrence. No child who received less than 35 Gy on average to both cochleae (n = 26) suffered from SNHL, whereas the 5-year SNHL cumulative incidence for the children who received greater than or equal to 35 Gy on average to either cochlea (n = 18) was 51.8 % ± 15.1 %. CONCLUSION Doses received by the inner ear canal and cochlea, associated with the age at RT initiation, are the main predictive factors for radiation-induced SNHL. A median dose to either cochlea over 35 Gy significantly increases the risk of SNHL and justify close audiometric monitoring to detect and equip hearing loss at an early stage.
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Affiliation(s)
- William Gehin
- Institut de Cancérologie de Lorraine, Radiotherapy, Nancy, France.
| | - Pascal Chastagner
- Centre Hospitalier Régional Universitaire de Nancy, Department of Pediatric Oncology, Nancy, France
| | - Ludovic Mansuy
- Centre Hospitalier Régional Universitaire de Nancy, Department of Pediatric Oncology, Nancy, France
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Zheng WJ, Guan XY, Fan KY, Gong J. Application of the CNS vital signs test and WISC-IV in the cognitive assessment of Chinese pediatric patients with intra-cranial space occupying lesion. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:229-238. [PMID: 36519237 DOI: 10.1080/21622965.2022.2156289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND A fast and reliable neurocognitive assessment tool is required for pediatric patients with an intracranial space-occupying lesion (ICSOL). METHODS A cross-sectional study was conducted on 41 pediatric patients having ICSOL. Cognitive abilities were assessed using both WISC-IV and CNS Vital Signs (CNS VS). All domains are compared to the normative data. Spearman's correlation analysis is performed between domains in two batteries. RESULTS In the WISC-IV, CPI, PSI, and WMI are significantly lower than the normative level. In the CNS VS, NCI, Memory domains, Reaction Time, Social Acuity, and Sustained Attention are significantly lower. Six domains in the CNS VS, including Complex Attention, Sustained Attention, Cognitive Flexibility, Executive Function, Processing Speed, and Social Acuity, positively correlate to the PSI or CPI in the WISC-IV. Sixty percent (9/15) of domains in the CNS VS negatively correlate to the size of ISCOL. The FSIQ in the WISC-IV is significantly associated with patients' parent education level. CONCLUSION Compared to the WISC-IV, CNS VS takes less time, but measures more domains. CNS VS is more sensitive to the size of ICSOL but is not affected by patients' parent education level. A healthy control group is warranted for interpreting the results in Chinese participants.
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Affiliation(s)
- Wen-Jian Zheng
- Department of Pediatric Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue-Yi Guan
- Department of Pediatric Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai-Yu Fan
- Department of Pediatric Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Gong
- Department of Pediatric Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Adamski J, Langford V, Finlay JL. Approaches to Minimise the Neurodevelopmental Impact of Choroid Plexus Carcinoma and Its Treatment. Life (Basel) 2023; 13:1855. [PMID: 37763259 PMCID: PMC10533047 DOI: 10.3390/life13091855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
Choroid plexus carcinomas (CPC) are rare aggressive tumours that primarily affect very young children. Treatment for CPC typically involves a combination of surgery, chemotherapy, and radiation therapy. Whilst considered necessary for a cure, these therapies have significant neurocognitive consequences for patients, negatively impacting cognitive function including memory, attention, executive functioning, and full-scale intelligence quotients (FSIQ). These challenges significantly impact the quality of life and ultimately socioeconomic parameters such as the level of educational attainment, marital status, and socioeconomic status. This review looks at the tumour- and treatment-related causes of neurocognitive damage in CPC patients and the progress made in finding strategies to reduce these. Opportunities to mitigate the neurodevelopmental consequences of surgery, chemotherapy, and radiation therapy are explored in the context of CPC treatment. Evaluation of the pathological and biological mechanisms of injury has identified innovative approaches to neurocognitive protection and neurorehabilitation, which aim to limit the neurocognitive damage. This review aims to highlight multiple approaches physicians can use when treating young children with CPC, to focus on neurocognitive outcomes as a measure of success.
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Affiliation(s)
- Jenny Adamski
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Vikki Langford
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Jonathan L. Finlay
- Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
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Hoornaert M, Laurent C, Lelong C, Deltenre P, Devroede B. A Rare Case of Unilateral Auditory Neuropathy Induced by Proton Therapy. Cureus 2023; 15:e45085. [PMID: 37842417 PMCID: PMC10568656 DOI: 10.7759/cureus.45085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Hearing loss (HL) is one of the most common complications of the treatment in head and neck oncology. Most cases of HL are due to the ototoxicity of platinum-based chemotherapy (PBC) - resulting usually in a symmetric bilateral sensorineural hearing loss (SNHL) - or radiotherapy. Radiation-induced SNHL is progressive, permanent, and dose-dependent. Total dose and follow-up time are important factors affecting incidence rates. However, the hearing consequences of proton radiation therapy (PRT), a radiation-type therapy especially used in pediatric malignancies of the central nervous system (CNS), remains unclear and poorly documented. We report here a case of a four-year-old patient with unilateral auditory neuropathy spectrum disorder (ANSD) related to PRT. This case highlights the need for appropriate auditory monitoring in patients undergoing PRT for CNS or head and neck malignancies.
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Affiliation(s)
- Mathilde Hoornaert
- Otolaryngology-Head and Neck Surgery, Erasme Hospital, Brussels University Hospital (HUB), Brussels, BEL
| | - Celine Laurent
- Otolaryngology-Head and Neck Surgery, Erasme Hospital, Brussels University Hospital (HUB), Brussels, BEL
| | - Clement Lelong
- Otolaryngology-Head and Neck Surgery, Erasme Hospital, Brussels University Hospital (HUB), Brussels, BEL
| | - Paul Deltenre
- Auditory Neurophysiology Laboratory, Brugmann Hospital, Brussels, BEL
| | - Benoit Devroede
- Otolaryngology-Head and Neck Surgery, Queen Fabiola Children's University Hospital, Brussels University Hospital (HUB), Brussels, BEL
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Brock P, Meijer A, Kogner P, Ansari M, Capra M, Geller J, Heuvel-Eibrink MVD, Knight K, Kruger M, Lindemulder S, Maibach R, O'Neill A, Papadakis V, Rajput K, Bleyer A, Bouffet E, Sullivan M. Sodium thiosulfate as cisplatin otoprotectant in children: The challenge of when to use it. Pediatr Blood Cancer 2023; 70:e30248. [PMID: 36772889 DOI: 10.1002/pbc.30248] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Penelope Brock
- Department of Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Annelot Meijer
- Department of Pediatric Oncology, Prinses Maxima Centrum, Utrecht, The Netherlands
| | - Per Kogner
- Department of Pediatric Oncology and Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Marc Ansari
- Pediatric Hematology and Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Michael Capra
- Paediatric Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | - James Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Kristin Knight
- Department of Pediatric Audiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Susan Lindemulder
- Department of Pediatric Oncology, Oregon Health and Science University, Portland, Oregon, USA
| | - Rudolf Maibach
- Department of Statistics, International Breast Cancer Study Group, Bern, Switzerland
| | - Allison O'Neill
- Children's Cancer and Blood Disorders Center, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Vassilios Papadakis
- Department of Pediatric Oncology, Agia Sofia Children's Hospital, Athens, Greece
| | - Kaukab Rajput
- Department of Paediatric Audiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Archie Bleyer
- Radiation Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Eric Bouffet
- Division of Pediatric Neuro-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Sullivan
- Children's Cancer Centre and Department of Paediatric Oncology, Royal Children's Hospital, Melbourne, Victoria, Australia
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7
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Coltin H, Pequeno P, Liu N, Tsang DS, Gupta S, Taylor MD, Bouffet E, Nathan PC, Ramaswamy V. The Burden of Surviving Childhood Medulloblastoma: A Population-Based, Matched Cohort Study in Ontario, Canada. J Clin Oncol 2023; 41:2372-2381. [PMID: 36696605 PMCID: PMC10150896 DOI: 10.1200/jco.22.02466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/05/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Survivors of childhood medulloblastoma suffer from substantial late effects. We characterized these sequelae using real-world health services data in a population-based cohort of medulloblastoma survivors. METHODS All 5-year medulloblastoma survivors diagnosed age < 18 years between 1987 and 2015 in Ontario, Canada, were identified and matched 1:5 with population controls. Index date was 5 years from latest pediatric cancer event. Linkage to provincial administrative health data allowed for comparison of cumulative incidences of several adverse outcomes. RESULTS Two hundred thirty survivors, 81.3% of whom had received craniospinal irradiation, were matched with 1,150 controls. The 10-year postindex cumulative incidence of all-cause mortality was 7.9% (95% CI, 3.9 to 11.8) in survivors versus 0.6% (95% CI, 0.1 to 1.1) in controls (hazard ratio [HR], 21.5; 95% CI, 9.8 to 54.0). The cumulative incidence of stroke was higher in survivors (4.8%; 95% CI, 2.2 to 9.0) compared with controls (0.1; 95% CI, 0.01 to 0.7; HR, 45.6; 95% CI, 12.8 to 289.8). Hearing loss requiring an amplification device was present in 24.9% (95% CI, 18.8 to 31.4) of survivors versus 0.3% (95% CI, 0.1 to 1.0) of controls (HR, 96.3; 95% CI, 39.7 to 317.3). Disability support prescription claims were submitted by 44.5% (95% CI, 37.1 to 51.6) of survivors versus 5.5% (95% CI, 4.2 to 7.1) of controls (HR, 10.0; 95% CI, 7.3 to 13.6). Female survivors were significantly less likely to deliver a liveborn child compared with controls (HR, 0.2; 95% CI, 0.1 to 0.7). CONCLUSION Survivors of medulloblastoma have significant long-term medical sequelae, increased all-cause mortality, and are frequently dependent on disability supports. Efforts to reduce the toxicity of current therapy, specifically incorporating molecularly informed risk stratification to spare low- and intermediate-risk survivors the toxicity of treatment, are urgently needed. These findings should prompt a re-evaluation of our current treatment approaches where research focused on late-effect interventions should be prioritized.
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Affiliation(s)
- Hallie Coltin
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Programme in Developmental and Stem Cell Biology, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | | | - Ning Liu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Derek S. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Michael D. Taylor
- Programme in Developmental and Stem Cell Biology, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C. Nathan
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Programme in Developmental and Stem Cell Biology, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Medical Biophysics and Paediatrics, University of Toronto, Toronto, Ontario, Canada
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8
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Impact of unilateral hearing loss in early development. Curr Opin Otolaryngol Head Neck Surg 2022; 30:344-350. [PMID: 36004776 DOI: 10.1097/moo.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on current literature as it relates to the impact of unilateral hearing loss for the pediatric population. RECENT FINDINGS Current studies further corroborate past research findings which reveal the potential consequences of unilateral hearing loss on spatial hearing, language, and neurocognitive functioning. Deficits among children with unilateral hearing loss may parallel those seen in children with bilateral hearing loss, further challenging historic views that hearing in one ear in childhood is sufficient for normal development. The potential deficiencies seen in children with unilateral hearing loss can be subtler than those seen with bilateral hearing loss, but may nonetheless also impact school performance, patient fatigue, parental stress, and quality of life. Early interventions within a sensitive period of development of the central auditory system may circumvent potential barriers in cognitive, academic, and psychosocial development. SUMMARY This review synthesizes the latest research on the impact of unilateral hearing loss in childhood and the role for possible interventions. The summarized information may serve to support the development of new guidelines for the evaluation and treatment of children with unilateral hearing loss.
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9
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Endogenous Retroviral Elements in Human Development and Central Nervous System Embryonal Tumors. J Pers Med 2021; 11:jpm11121332. [PMID: 34945804 PMCID: PMC8708524 DOI: 10.3390/jpm11121332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 01/21/2023] Open
Abstract
Human endogenous retroviruses (HERVs), which are critical to normal embryologic development and downregulated during normal maturation, have been implicated in a variety of cancers. Abnormal persistent production of HERVs has been suggested to play a role in oncogenesis and to confer stem cell properties to cells. We recently demonstrated that the most recently incorporated HERV element (HERV-K HML-2) has been associated with the pathogenesis of the embryonal atypical teratoid rhabdoid tumor (AT/RT), shifting our understanding of embryonal tumor development. HML-2 expression is vital for proper human development and its expression is suppressed via methylation or chromatin remodeling as cells differentiate. We previously found that dysfunctional chromatin remodeling due to loss of SMARCB1 expression induces HML-2 envelope (env) expression, impairing cellular differentiation and migration, and facilitating tumor growth in AT/RT. Epigenetic dysregulation in other embryonal tumors with concomitant expression of stem-cell markers may facilitate HML-2 expression. Future studies could utilize HML-2 as potential diagnostic criteria, use its expression as a treatment biomarker, and investigate the efficacy of therapies targeting cells with high HML-2 expression.
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10
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Moxon-Emre I, Dahl C, Ramaswamy V, Bartels U, Tabori U, Huang A, Cushing SL, Papaioannou V, Laperriere N, Bouffet E, Mabbott DJ. Hearing loss and intellectual outcome in children treated for embryonal brain tumors: Implications for young children treated with radiation sparing approaches. Cancer Med 2021; 10:7111-7125. [PMID: 34480430 PMCID: PMC8525144 DOI: 10.1002/cam4.4245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/07/2022] Open
Abstract
Purpose We investigate the impact of severe sensorineural hearing loss (SNHL) and for the first time evaluate the effect of unilateral versus bilateral SNHL on intellectual outcome in a cohort of children with embryonal brain tumors treated with and without radiation. Methods Data were from 94 childhood survivors of posterior fossa (PF) embryonal brain tumors who were treated with either: (1) chemotherapy alone (n = 16, 7.11 [3.41] years, 11M/5F), (2) standard‐dose craniospinal irradiation (CSI) and/or large boost volumes (n = 44, 13.05 [3.26] years, 29M/15F), or (3) reduced‐dose CSI with a boost restricted to the tumor bed (n = 34, 11.07 [3.80] years, 19M/15F). We compared intellectual outcome between children who: (1) did and did not develop SNHL and (2) developed unilateral versus bilateral SNHL. A Chang grade of ≥2b that required the use of a hearing aid was considered severe SNHL. Comparisons were made overall and within each treatment group separately. Results Patients who developed SNHL had lower full scale IQ (p = 0.007), verbal comprehension (p = 0.003), and working memory (p = 0.02) than patients without SNHL. No differences were observed between patients who had unilateral versus bilateral SNHL (all p > 0.05). Patients treated with chemotherapy alone who developed SNHL had lower mean working memory (p = 0.03) than patients who did not develop SNHL. Among patients treated with CSI, no IQ indices differed between those with and without SNHL (all p > 0.05). Conclusions Children treated for embryonal brain tumors who develop severe SNHL have lower intellectual outcome than patients with preserved hearing: this association is especially profound in young children treated with radiation sparing approaches. We also demonstrate that intellectual outcome is similarly impaired in patients who develop unilateral versus bilateral SNHL. These findings suggest that early intervention to preserve hearing is critical.
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Affiliation(s)
- Iska Moxon-Emre
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | - Christine Dahl
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Uri Tabori
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Annie Huang
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon L Cushing
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Vicky Papaioannou
- Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Communication Disorders, The Hospital for Sick Children, Toronto, ON, Canada
| | - Normand Laperriere
- Radiation Oncology, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, ON, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donald J Mabbott
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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