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Ahmad JG, Lovin BD, Lee A, Nader ME, Gidley PW. Cochlear Implantation After Head and Neck Radiation: A Case Series, Systematic Review, and Meta-analysis. Otol Neurotol 2024; 45:352-361. [PMID: 38361317 PMCID: PMC10940186 DOI: 10.1097/mao.0000000000004127] [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] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To determine if cochlear implant (CI) is safe and effective in patients with radiation therapy (XRT)-induced sensorineural hearing loss and to discuss considerations in this population through a retrospective cohort review, systematic review, and meta-analysis. DATABASES REVIEWED PubMed, Cochrane Library, and Embase. METHODS We retrospectively reviewed all CI cases after head and neck (HN) XRT at our institution, noting intraoperative findings, postoperative complications, and hearing outcomes. Change in speech discrimination scores (SDSs) was the primary outcome measure. Systematic review was performed to identify all cases of CI after HNXRT. A meta-analysis was performed to assess SDS change. RESULTS The retrospective cohort review identified 12 patients who underwent CI after HNXRT. One patient with HN cancer (HNC) and one with central nervous system pathology (CNSP) received bilateral implants. Six had HNC, three had CNSP, and one had Langerhans cell histiocytosis. Eleven had abnormal findings during CI. There were no postoperative complications. Twenty articles with an additional 97 patients were suitable for systematic review inclusion. Of the 109 patients, 67 (61.5%) had HNC and 18 (16.5%) had CNSP. Abnormal intraoperative findings were common (30.3%), most frequently in the mastoid (66.7%). Postoperative complications, including wound dehiscence and infection with some requiring explantation, occurred in 10.1% of patients. Sixty-six patients were included in the meta-analysis. All demonstrated SDS improvement (mean increase, 56.2%). CONCLUSION Patients with prior HNXRT benefit from CI. Paying careful attention to surgical planning and technique, postoperative care, and patient expectations is imperative, as complications are not uncommon.
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Affiliation(s)
- Jumah G. Ahmad
- Department of Otorhinolaryngology – Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Benjamin D. Lovin
- Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Lee
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul W. Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Scobioala S, Parfitt R, Matulat P, Byrne J, Langer T, Troschel FM, Hesping AE, Clemens E, Kaatsch P, Grabow D, Kaiser M, Spix C, Kremer LC, Calaminus G, Baust K, Kuehni CE, Weiss A, Strebel S, Kuonen R, Elsner S, Haupt R, Garré ML, Gruhn B, Kepak T, Kepakova K, Winther JF, Kenborg L, Rechnitzer C, Hasle H, Kruseova J, Luks A, Lackner H, Bielack S, Beck JD, Jürgens H, van den Heuvel-Eibrink MM, Zolk O, Eich HT, Am Zehnhoff-Dinnesen A. The impact of the temporal sequence of cranial radiotherapy and platin-based chemotherapy on hearing impairment in pediatric and adolescent CNS and head-and-neck cancer patients: A report from the PanCareLIFE consortium. Int J Cancer 2024; 154:320-331. [PMID: 37715472 DOI: 10.1002/ijc.34732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
The impact of the temporal sequence by which cranial radiotherapy (CRT) and platin-based chemotherapy (PCth) are administered on sensorineural hearing loss (SNHL) in pediatric and adolescent central nervous system (CNS) and head-and-neck (HN) cancer patients has not yet been studied in detail. We examined the ototoxic effects of sequentially applied CRT and PCth. This study included children and adolescents with CNS and HN tumors who participated in the multicountry PanCareLIFE (PCL) consortium. Audiological outcomes were compared between patients who received CRT prior to PCth and those who received it afterwards. The incidence, degree and posttreatment progression of SNHL, defined as Muenster classification grade ≥MS2b, were evaluated in 141 patients. One hundred and nineteen patients were included in a time-to-onset analysis. Eighty-eight patients received CRT prior to PCth (Group 1) and 53 patients received PCth before CRT (Group 2). Over a median follow-up time of 1.6 years, 72.7% of patients in Group 1 experienced SNHL ≥ MS2b compared to 33.9% in Group 2 (P < .01). A time-to-onset analysis was performed for 74 patients from Group 1 and 45 patients from Group 2. Median time to hearing loss (HL) ≥ MS2b was 1.2 years in Group 1 and 4.4 years in Group 2 (P < .01). Thus, audiological outcomes were better for patients who received CRT after PCth than before. This finding should be further evaluated and considered within clinical practice in order to minimize hearing loss in children and adolescents with CNS and HN tumors.
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Affiliation(s)
- Sergiu Scobioala
- Clinic for Radiotherapy, Radiooncology University Hospital Muenster, Muenster, Germany
| | - Ross Parfitt
- Department for Phoniatrics and Pedaudiology, University Hospital, Muenster, UKM, Germany
| | - Peter Matulat
- Department for Phoniatrics and Pedaudiology, University Hospital, Muenster, UKM, Germany
| | | | - Thorsten Langer
- Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, University of Luebeck, Luebeck, Germany
| | - Fabian M Troschel
- Clinic for Radiotherapy, Radiooncology University Hospital Muenster, Muenster, Germany
| | - Amélie E Hesping
- Department for Phoniatrics and Pedaudiology, University Hospital, Muenster, UKM, Germany
| | - Eva Clemens
- Erasmus University Medical Centre (EMC), Rotterdam, The Netherlands
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Melanie Kaiser
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Leontien C Kremer
- Academisch Medisch Centrum bij de Universiteit van Amsterdam (AMC), Amsterdam, The Netherlands
- Princess Maxima Center for Pediatric Oncology (PMC), and University of Utrecht, Utrecht, The Netherlands
| | - Gabriele Calaminus
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annette Weiss
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sven Strebel
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rahel Kuonen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Susanne Elsner
- Pediatric Oncology and Hematology, University Hospital for Children and Adolescents, University of Luebeck, Luebeck, Germany
| | - Riccardo Haupt
- DOPO Clinic and Neuroncology Unit, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini (IGG), Genoa, Italy
| | - Maria-Luisa Garré
- DOPO Clinic and Neuroncology Unit, Department of Hematology/Oncology, IRCCS Istituto Giannina Gaslini (IGG), Genoa, Italy
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Tomas Kepak
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Brno, Czech Republic
| | - Katerina Kepakova
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Brno, Czech Republic
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Catherine Rechnitzer
- Pediatric and Adolescent Medicine, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ales Luks
- Motol Teaching Hospital, Prague, Czech Republic
| | - Herwig Lackner
- Pediatric Hematology and Oncology, Medical University of Graz, Graz, Austria
| | - Stefan Bielack
- Pediatrics 5 (Oncology, Hematology, Immunology), Center for Pediatric, Adolescent, and Women's Medicine, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Jörn-Dirk Beck
- Pediatric Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Heribert Jürgens
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | | | - Oliver Zolk
- Institute of Clinical Pharmacology, Brandenburg Medical School, Rüdersdorf, Germany
| | - Hans Theodor Eich
- Clinic for Radiotherapy, Radiooncology University Hospital Muenster, Muenster, Germany
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Gupta D, Singh G, Garg P, Dey R, Singh B. Intratympanic Dexamethasone Role in Hearing Protection in Cancer Patients. Cureus 2023; 15:e44299. [PMID: 37779780 PMCID: PMC10534076 DOI: 10.7759/cureus.44299] [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: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction The study aims to determine the role of intratympanic dexamethasone (ITD) on the hearing profile of patients with head and neck cancer post-chemoradiotherapy. Study design This study employs a prospective case-control design. Subjects and methods In total 834 patients were evaluated for eligibility. Seven hundred and eleven were excluded because they didn't meet the inclusion criteria. A hundred cases out of 123 were diagnosed with head and neck cancer for which the treatment protocol included cisplatin concurrent to radiotherapy recruited. Before each cisplatin treatment session, ITD was injected into one ear (experimental ear) while the other ear of the same patient served as the control. Pure-tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAE) test results of the baseline and follow-up examinations in the sixth and 12th weeks were compared within and between the study and control ears. Results For pure tone thresholds, significant hearing threshold change was noticed at 8 kHz in the experimental group at six weeks and at ≥ 6 kHz in the control group. At 12 weeks, high frequencies were significantly affected at ≥ 4 kHz in the control group. When the baseline was compared across the groups in the 12th week, for otoacoustic emissions, high frequencies showed a loss in the control group more compared to the experimental side (Wilcoxon signed-rank test). Conclusion ITD functions less effectively at higher frequencies because the basal turn of the cochlea is more susceptible to cisplatin ototoxicity. ITD might have potential in the reduction of cisplatin-induced hearing loss.
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Affiliation(s)
- Dipti Gupta
- Ear, Nose, and Throat (ENT), Guru Gobind Singh Medical College and Hospital (GGSMCH), Faridkot, IND
| | - Gurbax Singh
- Otolaryngology - Head and Neck Surgery, Guru Gobind Singh Medical College and Hospital (GGSMCH), Faridkot, IND
| | - Pardeep Garg
- Radiotherapy, Guru Gobind Singh Medical College and Hospital (GGSMCH), Faridkot, IND
| | - Ratul Dey
- Audiology, Guru Gobind Singh Medical College and Hospital (GGSMCH), Faridkot, IND
| | - Baltej Singh
- Statistics, Guru Gobind Singh Medical College and Hospital (GGSMCH), Faridkot, IND
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Sahin M, Kaya A, Aytekin A, Akay E, Ozcan I. Tetramethylpyrazine Attenuates Radiation-Induced Ototoxicity in a Rat Model. Audiol Neurootol 2023; 28:427-435. [PMID: 37379818 DOI: 10.1159/000530685] [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: 12/26/2021] [Accepted: 04/10/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Tetramethylpyrazine (TMP) is a chemical compound, which has been shown to possess numerous biological features such as anticoagulation, inhibition of platelet aggregation, anti-inflammation, capillary dilatation, improvement in microcirculation, and protection against reactive oxygen radicals. The aim of the present study was to investigate the protective effect of TMP against radiation-induced ototoxicity. MATERIALS AND METHODS 40 rats were divided into four groups. The first group was irradiated for 5 days. The second group received a single dose of 140 mg/kg/day intraperitoneal TMP given to the rats 30 min before radiotherapy (RT) for 5 days. The third group received a single dose of 140 mg/kg/day i.p. TMP for 5 days, whereas the fourth group was administered saline. All rats underwent distortion product otoacoustic emission (DPOAE) and auditory brainstem response measurements before and after the application. The temporal bulla of animals was removed for immunohistopathological examination. RESULTS Signal-noise ratio values were significantly decreased in the RT group for the frequencies of 2-32 kHz after RT (p < 0.05), whereas the difference was not significant in terms of pre- and posttreatment values for the other groups. Also in the RT group, the ABR thresholds were significantly increased after treatment. In H&E staining, the mean scores for outer hair cells (OHCs), stria vascularis (SV), and spiral ganglion (SG) injuries were significantly higher in RT and RT + TMP groups than in the other groups. The mean OHCs and SV injury scores were also significantly higher in the RT group than in the RT + TMP group (p < 0.05). The number of cochleas that showed cytoplasmic caspase-3 immunoreactivity in the OHC, SV, and SG was significantly higher in RT and RT + TMP groups than in the other groups. CONCLUSION The findings of the present study suggest that TMP may have a therapeutic potential for preventing sensorineural hearing loss (SNHL) related to RT.
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Affiliation(s)
- Mustafa Sahin
- Department of Otorhinolaryngology and Head and Neck Surgery, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Altan Kaya
- Department of Otorhinolaryngology and Head and Neck Surgery, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Aynur Aytekin
- Department of Radiation Oncology, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Ebru Akay
- Department of Pathology, Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Ibrahim Ozcan
- Department of Otorhinolaryngology and Head and Neck Surgery, Kayseri City Training and Research Hospital, Kayseri, Turkey
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He YQ, Luo LT, Wang TM, Xue WQ, Yang DW, Li DH, Diao H, Xiao RW, Deng CM, Zhang WL, Liao Y, Wu YX, Wang QL, Zhou T, Li XZ, Zheng XH, Zhang PF, Zhang SD, Hu YZ, Sun Y, Jia WH. Clinical and genome-wide association analysis of chemoradiation-induced hearing loss in nasopharyngeal carcinoma. Hum Genet 2023; 142:759-772. [PMID: 37062025 PMCID: PMC10182145 DOI: 10.1007/s00439-023-02554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
Chemoradiation-induced hearing loss (CRIHL) is one of the most devasting side effects for nasopharyngeal carcinoma (NPC) patients, which seriously affects survivors' long-term quality of life. However, few studies have comprehensively characterized the risk factors for CRIHL. In this study, we found that age at diagnosis, tumor stage, and concurrent cisplatin dose were positively associated with chemoradiation-induced hearing loss. We performed a genome-wide association study (GWAS) in 777 NPC patients and identified rs1050851 (within the exon 2 of NFKBIA), a variant with a high deleteriousness score, to be significantly associated with hearing loss risk (HR = 5.46, 95% CI 2.93-10.18, P = 9.51 × 10-08). The risk genotype of rs1050851 was associated with higher NFKBIA expression, which was correlated with lower cellular tolerance to cisplatin. According to permutation-based enrichment analysis, the variants mapping to 149 hereditary deafness genes were significantly enriched among GWAS top signals, which indicated the genetic similarity between hereditary deafness and CRIHL. Pathway analysis suggested that synaptic signaling was involved in the development of CRIHL. Additionally, the risk score integrating genetic and clinical factors can predict the risk of hearing loss with a relatively good performance in the test set. Collectively, this study shed new light on the etiology of chemoradiation-induced hearing loss, which facilitates high-risk individuals' identification for personalized prevention and treatment.
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Affiliation(s)
- Yong-Qiao He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Lu-Ting Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tong-Min Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Wen-Qiong Xue
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Da-Wei Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Dan-Hua Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Hua Diao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ruo-Wen Xiao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Chang-Mi Deng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Wen-Li Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Ying Liao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Yan-Xia Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Qiao-Ling Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ting Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- Biobank of Sun Yat‑sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xi-Zhao Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- Biobank of Sun Yat‑sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xiao-Hui Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- Biobank of Sun Yat‑sen University Cancer Center, Guangzhou, People's Republic of China
| | - Pei-Fen Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- Biobank of Sun Yat‑sen University Cancer Center, Guangzhou, People's Republic of China
| | - Shao-Dan Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- Biobank of Sun Yat‑sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ye-Zhu Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China
- Biobank of Sun Yat‑sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wei-Hua Jia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People's Republic of China.
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
- Biobank of Sun Yat‑sen University Cancer Center, Guangzhou, People's Republic of China.
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Association of Clinical Aspects and Genetic Variants with the Severity of Cisplatin-Induced Ototoxicity in Head and Neck Squamous Cell Carcinoma: A Prospective Cohort Study. Cancers (Basel) 2023; 15:cancers15061759. [PMID: 36980643 PMCID: PMC10046479 DOI: 10.3390/cancers15061759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Cisplatin (CDDP) is a major ototoxic chemotherapy agent for head and neck squamous cell carcinoma (HNSCC) treatment. Clinicopathological features and genotypes encode different stages of CDDP metabolism, as their coexistence may influence the prevalence and severity of hearing loss. Methods: HNSCC patients under CDDP chemoradiation were prospectively provided with baseline and post-treatment audiometry. Clinicopathological features and genetic variants encoding glutathione S-transferases (GSTT1, GSTM1, GSTP1), nucleotide excision repair (XPC, XPD, XPF, ERCC1), mismatch repair (MLH1, MSH2, MSH3, EXO1), and apoptosis (P53, CASP8, CASP9, CASP3, FAS, FASL)-related proteins were analyzed regarding ototoxicity. Results: Eighty-nine patients were included, with a cumulative CDDP dose of 260 mg/m2. Moderate/severe ototoxicity occurred in 26 (29%) patients, particularly related to hearing loss at frequencies over 3000 Hertz. Race, body-mass index, and cumulative CDDP were independent risk factors. Patients with specific isolated and combined genotypes of GSTM1, GSTP1 c.313A>G, XPC c.2815A>C, XPD c.934G>A, EXO1 c.1762G>A, MSH3 c.3133A>G, FASL c.-844A>T, and P53 c.215G>C SNVs had up to 32.22 higher odds of presenting moderate/severe ototoxicity. Conclusions: Our data present, for the first time, the association of combined inherited nucleotide variants involved in CDDP efflux, DNA repair, and apoptosis with ototoxicity, which could be potential predictors in future clinical and genomic models.
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Bachtiary B, Veraguth D, Roos N, Pfiffner F, Leiser D, Pica A, Walser M, von Felten S, Weber DC. Hearing Loss in Cancer Patients with Skull Base Tumors Undergoing Pencil Beam Scanning Proton Therapy: A Retrospective Cohort Study. Cancers (Basel) 2022; 14:cancers14163853. [PMID: 36010847 PMCID: PMC9405884 DOI: 10.3390/cancers14163853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022] Open
Abstract
To assess the incidence and severity of changes in hearing threshold in patients undergoing high-dose pencil-beam-scanning proton therapy (PBS-PT). This retrospective cohort study included fifty-one patients (median 50 years (range, 13–68)) treated with PBS-PT for skull base tumors. No chemotherapy was delivered. Pure tone averages (PTAs)were determined before (baseline) and after PBS-PT as the average hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Hearing changes were calculated as PTA differences between pre-and post-PBS-PT. A linear mixed-effects model was used to assess the relationship between the PTA at the follow-up and the baseline, the cochlea radiation dose intensity, the increased age, and the years after PBS-PT. Included patients were treated for chordoma (n = 24), chondrosarcoma (n = 9), head and neck tumors (n = 9), or meningioma (n = 3), with a mean tumor dose of 71.1 Gy (RBE) (range, 52.0–77.8), and a mean dose of 37 Gy (RBE) (range, 0.0–72.7) was delivered to the cochleas. The median time to the first follow-up was 11 months (IQR, 5.5–33.7). The PTA increased from a median of 15 dB (IQR 10.0–25) at the baseline to 23.8 (IQR 11.3–46.3) at the first follow-up. In the linear mixed-effect model, the baseline PTA (estimate 0.80, 95%CI 0.64 to 0.96, p ≤ 0.001), patient’s age (0.30, 0.03 to 0.57, p = 0.029), follow-up time (2.07, 0.92 to 3.23, p ≤ 0.001), and mean cochlear dose in Gy (RBE) (0.34, 0.21 to 0.46, p ≤ 0.001) were all significantly associated with an increase in PTA at follow-up. The applied cochlear dose and baseline PTA, age, and time after treatment were significantly associated with hearing loss after proton therapy.
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Affiliation(s)
- Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
- Correspondence: ; Tel.: +41-56-310-2319
| | - Dorothe Veraguth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Nicolaas Roos
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Flurin Pfiffner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Dominic Leiser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Stefanie von Felten
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
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8
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Dillard LK, Lopez-Perez L, Martinez RX, Fullerton AM, Chadha S, McMahon CM. Global burden of ototoxic hearing loss associated with platinum-based cancer treatment: A systematic review and meta-analysis. Cancer Epidemiol 2022; 79:102203. [PMID: 35724557 PMCID: PMC9339659 DOI: 10.1016/j.canep.2022.102203] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/06/2022]
Abstract
Platinum-based chemotherapeutic agents cisplatin and carboplatin are widely used in cancer treatment worldwide and may result in ototoxic hearing loss. The high incidence of cancer and salient ototoxic effects of platinum-based compounds pose a global public health threat. The purpose of this study was twofold. First, to estimate the prevalence of ototoxic hearing loss associated with treatment with cisplatin and/or carboplatin via a systematic review and meta-analysis. Second, to estimate the annual global burden of ototoxic hearing loss associated with exposure to cisplatin and/or carboplatin. For the systematic review, three databases were searched (Ovid Medline, Ovid Embase, and Web of Science Core Collection) and studies that reported prevalence of objectively measured ototoxic hearing loss in cancer patients were included. A random effects meta-analysis determined pooled prevalence (95% confidence intervals [CI]) of ototoxic hearing loss overall, and estimates were stratified by treatment and patient attributes. Estimates of ototoxic hearing loss burden were created with published global estimates of incident cancers often treated with platinum-based compounds and cancer-specific treatment rates. Eighty-seven records (n = 5077 individuals) were included in the meta-analysis. Pooled prevalence of ototoxic hearing loss associated with cisplatin and/or carboplatin exposure was 43.17% [CI 37.93-48.56%]. Prevalence estimates were higher for regimens involving cisplatin (cisplatin only: 49.21% [CI 42.62-55.82%]; cisplatin & carboplatin: 56.05% [CI 45.12-66.43%]) versus carboplatin only (13.47% [CI 8.68-20.32%]). Our crude estimates of burden indicated approximately one million individuals worldwide are likely exposed to cisplatin and/or carboplatin, which would result in almost half a million cases of hearing loss per year, globally. There is an urgent need to reduce impacts of ototoxicity in cancer patients. This can be partially achieved by implementing existing strategies focused on primary, secondary, and tertiary hearing loss prevention. Primary ototoxicity prevention via otoprotectants should be a research and policy priority.
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Affiliation(s)
- Lauren K Dillard
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States.
| | - Lucero Lopez-Perez
- Cluster of Healthier Populations, World Health Organization, Geneva, Switzerland
| | - Ricardo X Martinez
- Cluster of Healthier Populations, World Health Organization, Geneva, Switzerland
| | - Amanda M Fullerton
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Shelly Chadha
- Department on Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Catherine M McMahon
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
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9
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Definition of an Normal Tissue Complication Probability Model for the Inner Ear in Definitive Radiochemotherapy of Nasopharynx Carcinoma. Cancers (Basel) 2022; 14:cancers14143422. [PMID: 35884484 PMCID: PMC9320660 DOI: 10.3390/cancers14143422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Definitive radiochemotherapy is the treatment of choice for locally advanced nasopharyngeal carcinoma. Due to the vicinity of the nasopharynx to the inner ear and the use of ototoxic platinum-based chemotherapy, there is a risk for irreversible damage to the auditory system. To avoid or minimize these critical side effects, radiation exposure to each inner ear must be balanced between target volume coverage and toxicity. However, normal tissue complication probability (NTCP) models of the inner ear validated by clinical data are rare. Patients and Methods: This retrospective study investigates the inner ear toxicity of 46 patients who received radio(chemo-)therapy for nasopharyngeal carcinoma at our institution from 2004 to 2021 according to CTCAE 5.0 criteria. For each inner ear, the mean (Dmean) and maximum (Dmax) dose in Gray (Gy) was evaluated and correlated with clinical toxicity data. Based on the data, an NTCP model and a cutoff dose logistic regression model (CDLR) were created. Results: In 11 patients (23.9%) hearing impairment and/or tinnitus was observed as a possible therapy-associated toxicity. Dmean was between 15−60 Gy, whereas Dmax was between 30−75 Gy. There was a dose-dependent, sigmoidal relation between inner ear dose and toxicity. A Dmean of 44 Gy and 65 Gy was associated with inner ear damage in 25% and 50% of patients, respectively. The maximum curve slope (m) was found at 50% and is m=0.013. The Dmax values showed a 25% and 50% complication probability at 58 Gy and 69 Gy, respectively, and a maximum slope of the sigmoid curve at 50% with m=0.025. Conclusion: There is a sigmoidal relation between radiation dose and incidence of inner ear toxicities. Dose constraints for the inner ear of <44 Gy (Dmean) or <58 Gy (Dmax) are suggested to limit the probability of inner ear toxicity <25%.
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10
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Ardeshirrouhanifard S, Fossa SD, Huddart R, Monahan PO, Fung C, Song Y, Dolan ME, Feldman DR, Hamilton RJ, Vaughn D, Martin NE, Kollmannsberger C, Dinh P, Einhorn L, Frisina RD, Travis LB. Ototoxicity After Cisplatin-Based Chemotherapy: Factors Associated With Discrepancies Between Patient-Reported Outcomes and Audiometric Assessments. Ear Hear 2022; 43:794-807. [PMID: 35067571 PMCID: PMC9010341 DOI: 10.1097/aud.0000000000001172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To provide new information on factors associated with discrepancies between patient-reported and audiometrically defined hearing loss (HL) in adult-onset cancer survivors after cisplatin-based chemotherapy (CBCT) and to comprehensively investigate risk factors associated with audiometrically defined HL. DESIGN A total of 1410 testicular cancer survivors (TCS) ≥6 months post-CBCT underwent comprehensive audiometric assessments (0.25 to 12 kHz) and completed questionnaires. HL severity was defined using American Speech-Language-Hearing Association criteria. Multivariable multinomial regression identified factors associated with discrepancies between patient-reported and audiometrically defined HL and multivariable ordinal regression evaluated factors associated with the latter. RESULTS Overall, 34.8% of TCS self-reported HL. Among TCS without tinnitus, those with audiometrically defined HL at only extended high frequencies (EHFs) (10 to 12 kHz) (17.8%) or at both EHFs and standard frequencies (0.25 to 8 kHz) (23.4%) were significantly more likely to self-report HL than those with no audiometrically defined HL (8.1%) [odds ratio (OR) = 2.48; 95% confidence interval (CI), 1.31 to 4.68; and OR = 3.49; 95% CI, 1.89 to 6.44, respectively]. Older age (OR = 1.09; 95% CI, 1.07 to 1.11, p < 0.0001), absence of prior noise exposure (OR = 1.40; 95% CI, 1.06 to 1.84, p = 0.02), mixed/conductive HL (OR = 2.01; 95% CI, 1.34 to 3.02, p = 0.0007), no hearing aid use (OR = 5.64; 95% CI, 1.84 to 17.32, p = 0.003), and lower education (OR = 2.12; 95% CI, 1.23 to 3.67, p = 0.007 for high school or less education versus postgraduate education) were associated with greater underestimation of audiometrically defined HL severity, while tinnitus was associated with greater overestimation (OR = 4.65; 95% CI, 2.64 to 8.20 for a little tinnitus, OR = 5.87; 95% CI, 2.65 to 13.04 for quite a bit tinnitus, and OR = 10.57; 95% CI, 4.91 to 22.79 for very much tinnitus p < 0.0001). Older age (OR = 1.13; 95% CI, 1.12 to 1.15, p < 0.0001), cumulative cisplatin dose (>300 mg/m2, OR = 1.47; 95% CI, 1.21 to 1.80, p = 0.0001), and hypertension (OR = 1.80; 95% CI, 1.28 to 2.52, p = 0.0007) were associated with greater American Speech-Language-Hearing Association-defined HL severity, whereas postgraduate education (OR = 0.58; 95% CI, 0.40 to 0.85, p = 0.005) was associated with less severe HL. CONCLUSIONS Discrepancies between patient-reported and audiometrically defined HL after CBCT are due to several factors. For survivors who self-report HL but have normal audiometric findings at standard frequencies, referral to an audiologist for additional testing and inclusion of EHFs in audiometric assessments should be considered.
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Affiliation(s)
| | | | | | | | - Chunkit Fung
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | | | | | | | - Paul Dinh
- Indiana University, Indianapolis, IN
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11
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Marcu LG. Gender and Sex-Related Differences in Normal Tissue Effects Induced by Platinum Compounds. Pharmaceuticals (Basel) 2022; 15:255. [PMID: 35215367 PMCID: PMC8876358 DOI: 10.3390/ph15020255] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/18/2022] Open
Abstract
Gender medicine in the field of oncology is an under-researched area, despite the existing evidence towards gender-dependent response to therapy and treatment-induced adverse effects. Oncological treatment aims to fulfil its main goal of achieving high tumour control by also protecting normal tissue from acute or chronic damage. Chemotherapy is an important component of cancer treatment, with a large number of drugs being currently in clinical use. Cisplatin is one of the most commonly employed chemotherapeutic agents, used either as a sole drug or in combination with other agents. Cisplatin-induced toxicities are well documented, and they include nephrotoxicity, neurotoxicity, gastrointestinal toxicity, ototoxicity, just to name the most frequent ones. Some of these toxicities have short-term sequelae, while others are irreversible. Furthermore, research showed that there is a strong gender-dependent aspect of side effects caused by the administration of cisplatin. While evidence towards sex differences in animal models is substantial, clinical studies considering sex/gender as a variable factor are limited. This work summarises the current knowledge on sex/gender-related side effects induced by platinum compounds and highlights the gaps in research that require more attention to open new therapeutic possibilities and preventative measures to alleviate normal tissue toxicity and increase patients' quality of life in both males and females.
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Affiliation(s)
- Loredana G. Marcu
- Faculty of Informatics & Science, Department of Physics, University of Oradea, 410087 Oradea, Romania;
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
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12
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Li G, Xia YF, Huang YX, Okat D, Qiu B, Doyen J, Bondiau PY, Benezery K, Gao J, Qian CN. Intensity-modulated proton radiation therapy as a radical treatment modality for nasopharyngeal carcinoma in China: A cost-effectiveness analysis. Head Neck 2021; 44:431-442. [PMID: 34837286 DOI: 10.1002/hed.26941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/11/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Compared to conventional intensity-modulated photon radiation therapy (IMRT), intensity-modulated proton radiation therapy (IMPT) has potential to reduce irradiation-induced late toxicities while maintaining excellent tumor control in patients with nasopharyngeal carcinoma (NPC). However, the relevant cost-effectiveness remains controversial. METHODS A Markov decision tree analysis was performed under the assumption that IMPT offered normal tissue complication probability reduction (NTCP reduction) in long-term dysphagia, xerostomia, and hearing loss, compared to IMRT. Base-case evaluation was performed on T2N2M0 NPC of median age (43 years old). A Chinese societal willingness-to-pay threshold (33558 US dollars [$])/quality-adjusted life-year [QALY]) was adopted. RESULTS For patients at median age and having NTCP reduction of 10%, 20%, 30%, 40%, 50%, and 60%, their incremental cost-effectiveness ratios were $102684.0/QALY, $43161.2/QALY, $24134.7/QALY, $13991.6/QALY, $8259.8/QALY, and $4436.1/QALY, respectively; IMPT should provide an NTCP reduction of ≥24% to be considered cost-effective. CONCLUSIONS IMPT has potential to be cost-effective for average Chinese NPC patients and should be validated clinically.
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Affiliation(s)
- Guo Li
- Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi-Xiang Huang
- Department of Health Management, Public Health Institute of Sun Yat-sen University, Guangzhou, China
| | - Deniz Okat
- Department of Finance, Hong Kong University of Science and Technology, Hong Kong, China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jerome Doyen
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Pierre-Yves Bondiau
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Karen Benezery
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France
| | - Jin Gao
- Division of Life Sciences and Medicine, Department of Radiation Oncology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Chao-Nan Qian
- Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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13
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Na G, Kim KH, Byun HK, Bae SH. Assessment of radiation-induced otitis media in patients with parotid gland malignancy. Acta Otolaryngol 2021; 141:466-470. [PMID: 33719909 DOI: 10.1080/00016489.2021.1892184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Otitis media with effusion (OME) is a known side effect of radiation therapy in patients with head and neck cancer. AIMS/OBJECTIVES To investigate the incidence rate and clinical course of radiation-induced OME, we have reported on the long-term characteristics of OME in patients with parotid gland malignancy. MATERIAL AND METHODS This cohort study assessed 200 patients who underwent post-parotidectomy radiation therapy from January 2010 to December 2019 in a tertiary referral center. Postoperative radiation therapy was performed at 6 weeks post-surgery. Serial magnetic resonance images were collected to detect otitis media. Two blinded otologists individually assessed data from radiation therapy initiation to 36 months of post-radiation therapy. RESULTS A total of 121 patients were enrolled (male, 61 [50.4%]; mean age, 46.98 ± 15.69 years), of which 14 developed otitis media (11.6%) within 6 months after radiation therapy. Spontaneous remission occurred without intervention within 1 year, excluding one patient who sustained otitis media for 2 years. CONCLUSIONS AND SIGNIFICANCE Radiation-induced OME occurred in 11.6% of patients and it remitted within 1 year without intervention. Therefore, cooperation between otolaryngologists and radiation oncologists is required and invasive intervention should be considered with careful risk-benefit evaluation.
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Affiliation(s)
- Gina Na
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Hoon Bae
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
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14
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Wang D, Shi S, Ren T, Zhang Y, Guo P, Wang J, Wang W. U0126 pretreatment inhibits cisplatin-induced apoptosis and autophagy in HEI-OC1 cells and cochlear hair cells. Toxicol Appl Pharmacol 2021; 415:115447. [PMID: 33577918 DOI: 10.1016/j.taap.2021.115447] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 02/08/2023]
Abstract
Deafness is the most common sensory disorder in the world. Ototoxic drugs are common inducing factors of sensorineural hearing loss, and cochlear hair cell (HC) damage is the main concern of the present studies. Cisplatin is a widely used, highly effective antitumor drug, but some patients have experienced irreversible hearing loss as a result of its application. This hearing loss is closely related to HC apoptosis and autophagy. U0126 is a specific inhibitor of the extracellular signal-regulated protein kinases 1 and 2 (ERK1/2) signaling pathway and has neuroprotective effects. For example, the neuroprotective effect of U0126 on ischemic stroke has been widely recognized. In neural cells, U0126 can prevent death due to excess glutamate, dopamine, or zinc ions. However, no studies of U0126 and ototoxic drug-induced injury have been reported to date. In the present study, we found that U0126 pretreatment significantly reduced the apoptosis and autophagy of HCs in auditory House Ear Institute-Organ of Corti 1 (HEI-OC1) cells and cochlear HCs. In addition, U0126 reduced the cisplatin-induced production of reactive oxygen species as well as the cisplatin-induced decrease in the mitochondrial membrane potential. These findings suggest that U0126 may be a potential therapeutic candidate for the prevention of cisplatin-induced ototoxicity.
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Affiliation(s)
- Dan Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200031, China
| | - Suming Shi
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200031, China
| | - Tongli Ren
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200031, China
| | - Yanping Zhang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200031, China
| | - Ping Guo
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200031, China
| | - Jiali Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200031, China
| | - Wuqing Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai 200031, China.
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15
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Cohen-Cutler S, Wong K, Mena V, Sianto K, Wright MA, Olch A, Orgel E. Hearing Loss Risk in Pediatric Patients Treated with Cranial Irradiation and Cisplatin-Based Chemotherapy. Int J Radiat Oncol Biol Phys 2021; 110:1488-1495. [PMID: 33677052 DOI: 10.1016/j.ijrobp.2021.02.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/23/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Cranial radiation therapy (RT) and cisplatin-based chemotherapy are essential to treating many pediatric cancers but cause significant ototoxicity. The objective of this study is to determine the relationship between the RT dose and the risk of subsequent hearing loss in pediatric patients treated with cisplatin. METHODS AND MATERIALS This retrospective study of cisplatin-treated pediatric patients examined ototoxicity from cranial RT. Ototoxicity was graded for each ear according to the International Society of Pediatric Oncology (SIOP) consensus ototoxicity scale. The RT dose to the cochlea was calculated using the mean, median, maximum, and minimum dose received to determine the most predictive parameter for hearing loss. Multivariable logistic regression models then examined risk factors for hearing loss. RESULTS In 96 children (161 ears) treated with RT + cisplatin, the minimum cochlear RT dose was most predictive of hearing loss. A higher cochlear RT dose was associated with increased hearing loss (odds ratio per 10 Gy dose increase = 1.64; P = .043), with an added risk in those receiving an autologous bone marrow transplantation (hazard ratio = 10.47; P < .001). CONCLUSIONS This research supports further testing of the minimum cochlear RT dose as a more predictive dose parameter for risk of ototoxicity. The cochlear RT dose was additive to the risk of hearing loss from underlying cisplatin-based chemotherapy. Exposure to autologous bone marrow transplantation was the strongest predictor of developing hearing loss, placing these children at particularly high risk for hearing loss across all cochlear doses. Future prospective studies are crucial to further inform RT dose thresholds and minimize the risk of hearing loss in childhood cancer survivors.
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Affiliation(s)
- Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Kenneth Wong
- Keck School of Medicine, University of Southern California, Los Angeles, California; Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Victoria Mena
- Department of Physical Medicine and Rehabilitation, Children's Hospital Los Angeles, Los Angeles, California
| | - Kevin Sianto
- Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Michael A Wright
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Arthur Olch
- Keck School of Medicine, University of Southern California, Los Angeles, California; Radiation Oncology Program, Children's Hospital Los Angeles, Los Angeles, California
| | - Etan Orgel
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California.
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16
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Wang D, Shi S, Hsieh YL, Wang J, Wang H, Wang W. Knockdown of sorcin increases HEI-OC1 cell damage induced by cisplatin in vitro. Arch Biochem Biophys 2021; 701:108752. [PMID: 33675811 DOI: 10.1016/j.abb.2021.108752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 12/29/2022]
Abstract
Hearing loss caused by ototoxic drugs is a kind of acquired hearing loss. Cisplatin is one of the most commonly used drugs and its main action sites are hair cells (HCs). Sorcin is a drug-resistant calcium-binding protein belonging to the small penta-EF-hand protein family. Sorcin is highly expressed in many tissues, including bone, heart, brain, lung, and skin tissues. Single-cell RNA sequencing showed that sorcin was expressed in the outer HCs of mice, but its role remained unknown. We also found that sorcin was highly expressed in the cytoplasm of cochlear HCs and HEI-OC1 cells. After cisplatin injury, the expression of sorcin in HCs and HEI-OC1 cells decreased significantly. SiRNA transfection technology was used to knock down the expression of sorcin. The results showed that the number of apoptotic cells, the expression of cleaved caspased-3, and the expression of Bax increased while the anti-apoptotic factor Bcl-2 decreased in the siRNA-Sorcin + CIS group. The observed increase in apoptosis was related to the increase of reactive oxygen species (ROS) and the destruction of the mitochondrial membrane potential (MMP). Finally, we found that the downregulated sorcin worked by activating the P-ERK1/2 signaling pathway. Overall, this study showed that sorcin can be used as a new target to prevent the ototoxicity of platinum drugs.
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Affiliation(s)
- Dan Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, 200031, China
| | - Suming Shi
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, 200031, China
| | - Yue-Lin Hsieh
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, 200031, China
| | - Jiali Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, 200031, China
| | - Hui Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, 200031, China
| | - Wuqing Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, 200031, China.
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17
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Swain SK, Samal S, Mohanty JN, Choudhury J. Nasopharyngeal carcinoma among the pediatric patients in a non-endemic region: our experience at a tertiary care teaching hospital in Eastern India. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [DOI: 10.1186/s43054-020-00036-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nasopharyngeal carcinoma (NPC) is an extremely rare malignant lesion among the pediatric age group. The relative rarity of pediatric NPC makes the diagnosis difficult. This rarity is often associated with delayed diagnosis which may lead to advanced loco-regional disease. Here, we study the clinical presentations, investigations, and treatment of nasopharyngeal carcinoma in the pediatric age group in a non-endemic region.
Result
This is a retrospective study where 21 pediatric patients were enrolled with age under 18 years. They were managed at a tertiary care teaching hospital between December 2010 and January 2019. Majority of the patients in this study were boys (66.7%). All children diagnosed with NPC were treated with radiotherapy covering entire nasopharynx and some children with chemotherapy. Until the patient is in a late stage, most children diagnosed with NPC were presenting with symptoms of neck mass (90.5%), bleeding from the nose (66.7%), nasal blockage (57.1%), and hearing loss (47.6%). Pathological report revealed WHO type III in the majority of the patients. All patients were treated with radiotherapy to primary and enlarged neck nodes.
Conclusion
Children with NPC have excellent survival except for those with distant metastatic disease. NPC in the pediatric age is usually not suspected clinically until patient in late stage. The TNM staging has the most relevant prognostic factor. Unfortunately, NPC tends to be locally advanced at the time of diagnosis in the pediatric age group and is sometimes associated with distant metastasis. In our study, most children were diagnosed with NPC along with neck node enlargement and were treated with radiotherapy. The diagnosis of pediatric NPC should prompt timely treatment.
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Mahdavi SR, Rezaeyan A, Nikoofar A, Bakhshandeh M, Farahani S, Cheraghi S. Comparison of radiation and chemoradiation-induced sensorineural hearing loss in head and neck cancer patients. J Cancer Res Ther 2020; 16:539-545. [PMID: 32719264 DOI: 10.4103/jcrt.jcrt_891_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim The purpose of this study was to assess and compare the incidence and severity of sensorineural hearing loss (SNHL) in head-and-neck patients undergoing radiotherapy (RT) and concurrent cisplatin-based chemoradiotherapy (CRT). Materials and Methods Pure tone audiometry (PTA) was performed at 0.25-12 kHz on 35 RT and 25 CRT patients after 12-month followed up. The hearing loss was evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) criteria. Results SNHL increased to 84% in patients who had received CRT, compared with 26% increasing in patients who had treated with RT. There was an increased risk of SNHL at all frequencies for ears received a cochlear mean dose >50 Gy in RT group, compared to those receiving cochlear mean dose >30 Gy in CRT group. SNHL was more severe at higher frequencies in both patient groups. Conclusion Characteristic of radiation-induced SNHL is different from CRT-induced SNHL, especially in threshold radiation dose and PTA frequency.
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Affiliation(s)
- Seied Rabi Mahdavi
- Radiation Biology Research Center; Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abolhasan Rezaeyan
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikoofar
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiation Technology, Allied Medicine Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Farahani
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Susan Cheraghi
- Radiation Biology Research Center; Department of Radiation Sciences, Allied Medicine Faculty, Iran University of Medical Sciences, Tehran, Iran
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Dose-response relationship and normal-tissue complication probability of conductive hearing loss in patients undergoing head-and-neck or cranial radiotherapy: A prospective study including 70 ears. Phys Med 2019; 61:64-69. [DOI: 10.1016/j.ejmp.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 03/16/2019] [Accepted: 04/06/2019] [Indexed: 11/22/2022] Open
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Lu S, Wei J, Sun F, Xiao W, Cai R, Zhen Z, Zhu J, Wang J, Huang J, Lu L, Sun X, Gao Y. Late Sequelae of Childhood and Adolescent Nasopharyngeal Carcinoma Survivors After Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 103:45-51. [DOI: 10.1016/j.ijrobp.2018.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
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Morton LM, Kerns SL, Dolan ME. Role of Germline Genetics in Identifying Survivors at Risk for Adverse Effects of Cancer Treatment. Am Soc Clin Oncol Educ Book 2018; 38:775-786. [PMID: 30231410 DOI: 10.1200/edbk_201391] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The growing population of cancer survivors often faces adverse effects of treatment, which have a substantial impact on morbidity and mortality. Although certain adverse effects are thought to have a significant heritable component, much work remains to be done to understand the role of germline genetic factors in the development of treatment-related toxicities. In this article, we review current understanding of genetic susceptibility to a range of adverse outcomes among cancer survivors (e.g., fibrosis, urinary and rectal toxicities, ototoxicity, chemotherapy-induced peripheral neuropathy, subsequent malignancies). Most previous research has been narrowly focused, investigating variation in candidate genes and pathways such as drug metabolism, DNA damage and repair, and inflammation. Few of the findings from these earlier candidate gene studies have been replicated in independent populations. Advances in understanding of the genome, improvements in technology, and reduction in laboratory costs have led to recent genome-wide studies, which agnostically interrogate common and/or rare variants across the entire genome. Larger cohorts of patients with homogeneous treatment exposures and systematic ascertainment of well-defined outcomes as well as replication in independent study populations are essential aspects of the study design and are increasingly leading to the discovery of variants associated with each of the adverse outcomes considered in this review. In the long-term, validated germline genetic associations hold tremendous promise for more precisely identifying patients at highest risk for developing adverse treatment effects, with implications for frontline therapy decision-making, personalization of long-term follow-up guidelines, and potential identification of targets for prevention or treatment of the toxicity.
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Affiliation(s)
- Lindsay M Morton
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute at the National Institutes of Health, Bethesda, MD; Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY; Department of Medicine, University of Chicago, Chicago, IL
| | - Sarah L Kerns
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute at the National Institutes of Health, Bethesda, MD; Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY; Department of Medicine, University of Chicago, Chicago, IL
| | - M Eileen Dolan
- From the Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute at the National Institutes of Health, Bethesda, MD; Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY; Department of Medicine, University of Chicago, Chicago, IL
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Zhang C, Liu LX, Li WZ, Liang W, Chen ZH, Huang XH, Qi J, Chen XH, Liang JG, Cao XL. Cochlea sparing with a stratified scheme of dose limitation employed in intensity-modulated radiotherapy for nasopharyngeal carcinoma: A dosimetry study. Med Dosim 2018; 44:226-232. [PMID: 30268345 DOI: 10.1016/j.meddos.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/27/2018] [Accepted: 08/06/2018] [Indexed: 12/25/2022]
Abstract
Hearing loss is 1 of the major complications after radiotherapy in nasopharyngeal carcinoma (NPC) patients, how to minimize dose to cochlea in order to reduce the incidence of sensorineural hearing loss is a critical task. This study is to investigate a stratified scheme of cochlea sparing based on T stage in intensity-modulated radiotherapy. We designed a comparison between 2 plans of cochlea sparing plan (C-Plan) and regular noncochlea sparing plan (R-Plan) from 19 NPC patients with 2, 3, 8, and 6 cases of T1, T2, T3, and T4 stage, respectively. The outcomes showed that target coverage parameters and dose-volume histogram features were of no significant difference, with a significant difference in dose distribution between C-Plan and R-Plan in cochlea and eustachian, e.g., ipsilateral cochlea Dmean 4619.75 ± 1134.09 cGy in C-Plan and 5061.03 ± 1121.09 cGy in R-Plan (p = 0.000), contralateral cochlea Dmean 4386.73 ± 945.14 cGy in C-Plan and 4991.38 ± 961.21 cGy in R-Plan (p = 0.000). Meanwhile, there was no significant difference in dose distribution in spinal cord, brainstem, and other OARs. Our dosimetry study showed cochlea sparing in intensity-modulated radiotherapy for NPC reduced cochlea dose to different extent, so we suggested a stratified scheme of cochlea sparing based on T stage could be a useful and practical tool for both physicists and radiation doctors.
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Affiliation(s)
- Chao Zhang
- Oncology Department, Panyu Central Hospital, Guangzhou 510060, China.
| | - Ling-Xiang Liu
- Oncology Department, Panyu Central Hospital, Guangzhou 510060, China
| | - Wei-Zhan Li
- Oncology Department, Panyu Central Hospital, Guangzhou 510060, China
| | - Wen Liang
- ENT Department, Panyu Central Hospital, Guangzhou 510060, China
| | - Zhao-Hui Chen
- Oncology Department, Panyu Central Hospital, Guangzhou 510060, China
| | - Xian-Hai Huang
- Oncology Department, Panyu Central Hospital, Guangzhou 510060, China
| | - Juan Qi
- Statistics Room, Medical Affairs Department, Panyu Central Hospital, Guangzhou 510060, China
| | - Xiao-Hua Chen
- Oncology Department, Panyu Central Hospital, Guangzhou 510060, China
| | - Jian-Gang Liang
- ENT Department, Panyu Central Hospital, Guangzhou 510060, China
| | - Xiao-Long Cao
- Oncology Department, Panyu Central Hospital, Guangzhou 510060, China
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Radiation dose constraints for organs at risk in neuro-oncology; the European Particle Therapy Network consensus. Radiother Oncol 2018; 128:26-36. [PMID: 29779919 DOI: 10.1016/j.radonc.2018.05.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/16/2018] [Accepted: 05/01/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE For unbiased comparison of different radiation modalities and techniques, consensus on delineation of radiation sensitive organs at risk (OARs) and on their dose constraints is warranted. Following the publication of a digital, online atlas for OAR delineation in neuro-oncology by the same group, we assessed the brain OAR-dose constraints in a follow-up study. METHODS We performed a comprehensive search to identify the current papers on OAR dose constraints for normofractionated photon and particle therapy in PubMed, Ovid Medline, Cochrane Library, Embase and Web of Science. Moreover, the included articles' reference lists were cross-checked for potential studies that met the inclusion criteria. Consensus was reached among 20 radiation oncology experts in the field of neuro-oncology. RESULTS For the OARs published in the neuro-oncology literature, we summarized the available literature and recommended dose constraints associated with certain levels of normal tissue complication probability (NTCP) according to the recent ICRU recommendations. For those OARs with lacking or insufficient NTCP data, a proposal for effective and efficient data collection is given. CONCLUSION The use of the European Particle Therapy Network-consensus OAR dose constraints summarized in this article is recommended for the model-based approach comparing photon and proton beam irradiation as well as for prospective clinical trials including novel radiation techniques and/or modalities.
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Hearing Loss in Adult Survivors of Childhood Cancer Treated with Radiotherapy. CHILDREN-BASEL 2018; 5:children5050059. [PMID: 29734694 PMCID: PMC5977041 DOI: 10.3390/children5050059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 01/21/2023]
Abstract
The ototoxic effects of radiotherapy have been poorly characterized. We examined adult survivors of childhood cancer who were treated with radiotherapy, which included the head, before the age of 22 years and between 1952 and 2016. Those who received platinum chemotherapy were excluded. Demographic, diagnosis, and treatment outcomes were captured. Audiograms were graded using the Chang and International Society of Paediatric Oncology ototoxicity (SIOP) scales. Among 276 patients with a history of radiation to sites that included the brain, orbit, nasopharynx, and total body irradiation, the median age at treatment was 10.1 years and 59% were male. Of 51 survivors who had post-treatment audiograms, 19 demonstrated severe hearing impairment according to both the Chang and SIOP scales after a median follow-up of 16.6 years. Of those with severe impairment, 10 were using hearing aids. Among the 23 patients with more than one audiogram, five had normal hearing on the first audiogram but hearing loss upon subsequent study. Ototoxic effects of radiotherapy are present in a significant portion of survivors, but impairment may present over time, and our results suggest that many are not being screened. Further, among patients with severe hearing loss, use of hearing aids is not universal. Expansion of access to audiology testing and hearing interventions may be warranted.
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The Effect of Radiation Therapy on Hearing Loss in Patients with Head and Neck Cancer. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.10421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chan SL, Ng LS, Goh X, Siow CH, Goh HL, Goh BC, Cheo T, Loh KS, Brunham LR. Time course and clinical characterization of cisplatin-induced ototoxicity after treatment for nasopharyngeal carcinoma in a South East Asian population. Head Neck 2018; 40:1425-1433. [PMID: 29451951 DOI: 10.1002/hed.25112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/05/2017] [Accepted: 01/23/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to characterize the clinical course of hearing loss in patients with nasopharyngeal carcinoma (NPC) and the clinical factors affecting its severity. METHODS The time course of hearing loss in patients with NPC was assessed using threshold shift from baseline and Common Terminology Criteria for Adverse Events (CTCAE) grade. RESULTS In the chemoradiotherapy (CRT) groups, the threshold shift was significantly higher from 3 months at 4 kHz (P = 2.30 × 10-9 , concurrent CRT only) but not within 2 years posttreatment in the radiotherapy (RT) group. The CRT groups had worse CTCAE grades than the RT group (percentage of latest CTCAE grade ≥1: 64.9% vs 29.0%, respectively). Cumulative cisplatin dose and cochlear RT dose significantly affects threshold shifts, especially at high frequencies. CONCLUSION Although cisplatin led to high frequency hearing impairment from about 3 months posttreatment, RT conferred no significant hearing impairment in the first 2 years.
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Affiliation(s)
- Sze Ling Chan
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology, and Research, Singapore
| | - Li Shia Ng
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Xueying Goh
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Chor Hiang Siow
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Han Lee Goh
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Boon Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.,Cancer Science Institute, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University Health System, Singapore.,Haematology Oncology Research Group, National University Cancer Institute, National University Health System, Singapore
| | - Timothy Cheo
- Department of Radiation Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology - Head and Neck Surgery, National University Health System, Singapore
| | - Liam R Brunham
- Translational Laboratory in Genetic Medicine, Agency for Science, Technology, and Research, Singapore.,Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, National University of Singapore, Singapore
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Fluvastatin protects cochleae from damage by high-level noise. Sci Rep 2018; 8:3033. [PMID: 29445111 PMCID: PMC5813011 DOI: 10.1038/s41598-018-21336-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/02/2018] [Indexed: 02/06/2023] Open
Abstract
Exposure to noise and ototoxic drugs are responsible for much of the debilitating hearing loss experienced by about 350 million people worldwide. Beyond hearing aids and cochlear implants, there have been no other FDA approved drug interventions established in the clinic that would either protect or reverse the effects of hearing loss. Using Auditory Brainstem Responses (ABR) in a guinea pig model, we demonstrate that fluvastatin, an inhibitor of HMG-CoA reductase, the rate-limiting enzyme of the mevalonate pathway, protects against loss of cochlear function initiated by high intensity noise. A novel synchrotron radiation based X-ray tomographic method that imaged soft tissues at micrometer resolution in unsectioned cochleae, allowed an efficient, qualitative evaluation of the three-dimensional internal structure of the intact organ. For quantitative measures, plastic embedded cochleae were sectioned followed by hair cell counting. Protection in noise-exposed cochleae is associated with retention of inner and outer hair cells. This study demonstrates the potential of HMG-CoA reductase inhibitors, already vetted in human medicine for other purposes, to protect against noise induced hearing loss.
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Woods K, Lee P, Kaprealian T, Yang I, Sheng K. Cochlea-sparing acoustic neuroma treatment with 4π radiation therapy. Adv Radiat Oncol 2018; 3:100-107. [PMID: 29904732 PMCID: PMC6000182 DOI: 10.1016/j.adro.2018.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/28/2017] [Accepted: 01/31/2018] [Indexed: 11/04/2022] Open
Abstract
Purpose This study investigates whether 4π noncoplanar radiation therapy can spare the cochleae and consequently potentially improve hearing preservation in patients with acoustic neuroma who are treated with radiation therapy. Methods and materials Clinical radiation therapy plans for 30 patients with acoustic neuroma were included (14 stereotactic radiation surgery [SRS], 6 stereotactic radiation therapy [SRT], and 10 intensity modulated radiation therapy [IMRT]). The 4π plans were created for each patient with 20 optimal beams selected using a greedy column generation method and subsequently recalculated in Eclipse for comparison. Organ-at-risk (OAR) doses, homogeneity index, conformity, and tumor control probability (TCP) were compared. Normal tissue complication probability (NTCP) was calculated for sensorineural hearing loss (SNHL) at 3 and 5 years posttreatment. The dose for each plan was then escalated to achieve 99.5% TCP. Results 4π significantly reduced the mean dose to both cochleae by 2.0 Gy (32%) for SRS, 3.2 Gy (29%) for SRT, and 10.0 Gy (32%) for IMRT. The maximum dose to both cochleae was also reduced with 4π by 1.6 Gy (20%), 2.2 Gy (15%), and 7.1 Gy (18%) for SRS, SRT, and IMRT plans, respectively. The reductions in mean/maximum brainstem dose with 4π were also statistically significant. Mean doses to other OARs were reduced by 19% to 56% on average. 4π plans had a similar CN and TCP, with a significantly higher average homogeneity index (0.93 vs 0.92) and significantly lower average NTCP for SNHL at both 3 years (30.8% vs 40.8%) and 5 years (43.3% vs 61.7%). An average dose escalation of approximately 116% of the prescription dose achieved 99.5% TCP, which resulted in 32.6% and 43.4% NTCP for SNHL at 3 years and 46.4% and 64.7% at 5 years for 4π and clinical plans, respectively. Conclusions Compared with clinical planning methods, optimized 4π radiation therapy enables statistically significant sparing of the cochleae in acoustic neuroma treatment as well as lowering of other OAR doses, potentially reducing the risk of hearing loss.
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Affiliation(s)
- Kaley Woods
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Percy Lee
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Tania Kaprealian
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
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Yao JJ, Chen FP, Zhou GQ, Zhang WJ, Xu L, Wang XJ, Lin L, Ma J, Sun Y. A prospective study on radiation doses to organs at risk (OARs) during intensity-modulated radiotherapy for nasopharyngeal carcinoma patients. Oncotarget 2017; 7:21742-52. [PMID: 26942881 PMCID: PMC5008319 DOI: 10.18632/oncotarget.7826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/21/2016] [Indexed: 12/05/2022] Open
Abstract
This study is to investigate the dose distribution of organs at risk (OARs) in cases of nasopharyngeal carcinoma (NPC). From July 2013 to October 2014, a prospective cohort study involving 148 patients was carried out at our center. OARs surrounding the nasopharynx were contoured on axial CT planning images in all patients. Dose-volume histograms of OARs and gross tumor volumes (GTV) were calculated. Multivariate analysis showed that radiation dose to OARs was associated with T stage and, especially, GTV. Seven OARs, including the spinal cord, eye and mandible, easily tolerated radiation doses in all patients; six OARs including the brain stem, chiasm and temporal lobe easily tolerated radiation doses in patients with a small GTV, but with difficulty when GTV was large; and other nine OARs including the parotid gland, cochlea and tympanic cavity met tolerance doses with difficulty in all patients. According to the patterns of radiation doses to OARs, it may help us to further reduce subsequent complications by improving the efficiency of plan optimization and evaluation.
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Affiliation(s)
- Ji-Jin Yao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China
| | - Fo-Ping Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China
| | - Wang-Jian Zhang
- Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, People's Republic of China
| | - Lin Xu
- Department of Oncology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, People's Republic of China
| | - Xiao-Ju Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China
| | - Li Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, People's Republic of China
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Normal tissue complication probability modeling of radiation-induced sensorineural hearing loss after head-and-neck radiation therapy. Int J Radiat Biol 2017; 93:1327-1333. [DOI: 10.1080/09553002.2017.1385872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Impact of radiation technique, radiation fraction dose, and total cisplatin dose on hearing : Retrospective analysis of 29 medulloblastoma patients. Strahlenther Onkol 2017; 193:910-920. [PMID: 28887665 DOI: 10.1007/s00066-017-1205-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/17/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To analyze the incidence and degree of sensorineural hearing loss (SNHL) resulting from different radiation techniques, fractionation dose, mean cochlear radiation dose (Dmean), and total cisplatin dose. MATERIAL AND METHODS In all, 29 children with medulloblastoma (58 ears) with subclinical pretreatment hearing thresholds participated. Radiotherapy (RT) and cisplatin had been applied sequentially according to the HIT MED Guidance. Audiological outcomes up to the latest follow-up (median 2.6 years) were compared. RESULTS Bilateral high-frequency SNHL was observed in 26 patients (90%). No significant differences were found in mean hearing threshold between left and right ears at any frequency. A significantly better audiological outcome (p < 0.05) was found after tomotherapy at the 6 kHz bone-conduction threshold (BCT) and left-sided 8 kHz air-conduction threshold (ACT) than after a combined radiotherapy technique (CT). Fraction dose was not found to have any impact on the incidence, degree, and time-to-onset of SNHL. Patients treated with CT had a greater risk of SNHL at high frequencies than tomotherapy patients even though Dmean was similar. Increase in severity of SNHL was seen when the total cisplatin dose reached above 210 mg/m2, with the highest abnormal level found 8-12 months after RT regardless of radiation technique or fraction dose. CONCLUSION The cochlear radiation dose should be kept as low as possible in patients who receive simultaneous cisplatin-based chemotherapy. The risk of clinically relevant HL was shown when Dmean exceeds 45 Gy independent of radiation technique or radiation regime. Cisplatin ototoxicity was shown to have a dose-dependent effect on bilateral SNHL, which was more pronounced in higher frequencies.
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Kim YR, Jung DJ, Oh SK, Lee T, Lee IK, Lee KY, Kim UK. Protective effects of 1,2,3-triazole derivative KPR-A020 against cisplatin-induced ototoxicity in murine cochlear cultures. Int J Pediatr Otorhinolaryngol 2017; 96:59-64. [PMID: 28390615 DOI: 10.1016/j.ijporl.2017.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/24/2017] [Accepted: 02/25/2017] [Indexed: 11/26/2022]
Abstract
Cisplatin (cis-diaminedichloridoplatinum(II), cis-[PtCl2(NH3)2]) is an effective chemotherapeutic agent in the treatment of several types of malignant solid tumors but its clinical use is associated with ototoxicity. Several studies have investigated the effect of antioxidants on cisplatin-induced ototoxicity in mice. The triazole KPR-A020 has been shown to play a protective role against mitochondrial dysfunction by reducing the production of mitochondrial reactive oxygen species (ROS). The effect of KPR-A020 on cisplatin-induced ototoxicity was examined using cultures of cochlear explants. Healthy mice were randomly divided into 4 groups: control, treated with cisplatin alone (CP), treated with cisplatin and KPR-A020 (CP + KPR-A020), and treated with KPR-A020 alone (KPR-A020). The cochlear explants were harvested for histological and immunohistochemical examinations. Biochemical analyses of the explants revealed that pre-treatment with KPR-A020 prevented an increase in mitochondrial ROS levels. Moreover, the CP + KPR-A020 group showed better hair cell survival than the CP group. Immunohistochemical examinations of cochlear explants stained with anti-caspase-3 revealed greater immunopositivity in the CP group. The CP + KPR-A020 group showed significantly less immunopositivity than the CP group (P < 0.05). Thus, it appears that KPR-A020 protects hair cells in the organ of Corti from cisplatin-induced toxicity by decreasing the production of mitochondrial ROS. The results of this study suggest that KPR-A020 can be used as an antioxidant and antiapoptotic agent to prevent hearing loss caused by cisplatin induced-oxidative stress.
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Affiliation(s)
- Ye-Ri Kim
- Department of Biology, College of Natural Sciences, Kyungpook National University, Daegu, Republic of Korea; School of Life Sciences, BK21 Plus KNU Creative BioResearch Group, Kyungpook National University, Daegu, Republic of Korea.
| | - Da Jung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
| | - Se-Kyung Oh
- Laboratory Animal Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea.
| | - Taeho Lee
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Kyungpook National University, Daegu, Republic of Korea.
| | - In-Kyu Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea; Leading-edge Research Center for Drug Discovery and Development for Diabetes and Metabolic Disease, Kyungpook National University Hospital, Daegu, Republic of Korea.
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
| | - Un-Kyung Kim
- Department of Biology, College of Natural Sciences, Kyungpook National University, Daegu, Republic of Korea; School of Life Sciences, BK21 Plus KNU Creative BioResearch Group, Kyungpook National University, Daegu, Republic of Korea.
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Shorter P, Harden F, Owen R, Panizza B, Burmeister B, Sommerville J, Mengersen K, Foote M. Risk Profiles for Sensorineural Hearing Loss in Patients with Head and Neck Cancer Receiving Cisplatin-based Chemoradiation. J Med Imaging Radiat Sci 2017; 48:61-67. [DOI: 10.1016/j.jmir.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/23/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
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Espenel S, Garcia MA, Guy JB, Vallard A, Ben Mrad M, Langrand-Escure J, El Meddeb Hamrouni A, Trone JC, Xia Y, Rancoule C, Magné N. Ototoxicité radio-induite et chimio-induite dans les cancers ORL : de la prévention primaire à la prévention tertiaire. Cancer Radiother 2017; 21:77-83. [DOI: 10.1016/j.canrad.2016.08.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 12/21/2022]
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Guimas V, Thariat J, Graff-Cailleau P, Boisselier P, Pointreau Y, Pommier P, Montbarbon X, Laude C, Racadot S. Radiothérapie conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures, dose de tolérance des tissus sains : appareil cochléovestibulaire et tronc cérébral. Cancer Radiother 2016; 20:475-83. [DOI: 10.1016/j.canrad.2016.07.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 12/25/2022]
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Frisina RD, Wheeler HE, Fossa SD, Kerns SL, Fung C, Sesso HD, Monahan PO, Feldman DR, Hamilton R, Vaughn DJ, Beard CJ, Budnick A, Johnson EM, Ardeshir-Rouhani-Fard S, Einhorn LH, Lipshultz SE, Dolan ME, Travis LB. Comprehensive Audiometric Analysis of Hearing Impairment and Tinnitus After Cisplatin-Based Chemotherapy in Survivors of Adult-Onset Cancer. J Clin Oncol 2016; 34:2712-20. [PMID: 27354478 PMCID: PMC5019759 DOI: 10.1200/jco.2016.66.8822] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Cisplatin is widely used but highly ototoxic. Effects of cumulative cisplatin dose on hearing loss have not been comprehensively evaluated in survivors of adult-onset cancer. PATIENTS AND METHODS Comprehensive audiological measures were conducted on 488 North American male germ cell tumor (GCT) survivors in relation to cumulative cisplatin dose, including audiograms (0.25 to 12 kHz), tests of middle ear function, and tinnitus. American Speech-Language-Hearing Association criteria defined hearing loss severity. The geometric mean of hearing thresholds (0.25 to 12 kHz) summarized overall hearing status consistent with audiometric guidelines. Patients were sorted into quartiles of hearing thresholds of age- and sex-matched controls. RESULTS Increasing cumulative cisplatin dose (median, 400 mg/m(2); range, 200 to 800 mg/m(2)) was significantly related to hearing loss at 4, 6, 8, 10, and 12 kHz (P trends, .021 to < .001): every 100 mg/m(2) increase resulted in a 3.2-dB impairment in age-adjusted overall hearing threshold (4 to 12 kHz; P < .001). Cumulative cisplatin doses > 300 mg/m(2) were associated with greater American Speech-Language-Hearing Association-defined hearing loss severity (odds ratio, 1.59; P = .0066) and worse normative-matched quartiles (odds ratio, 1.33; P = .093) compared with smaller doses. Almost one in five (18%) patients had severe to profound hearing loss. Tinnitus (40% patients) was significantly correlated with reduced hearing at each frequency (P < .001). Noise-induced damage (10% patients) was unaffected by cisplatin dose (P = .59). Hypertension was significantly related (P = .0066) to overall hearing threshold (4 to 12 kHz) in age- and cisplatin dose-adjusted analyses. Middle ear deficits occurred in 22.3% of patients but, as expected, were not related to cytotoxic drug dosage. CONCLUSION Follow-up of adult-onset cancer survivors given cisplatin should include routine inquiry for hearing status and tinnitus, referral to audiologists as clinically indicated, and hypertension control. Patients should be urged to avoid noise exposure, ototoxic drugs, and other factors that further damage hearing.
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Affiliation(s)
- Robert D Frisina
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Heather E Wheeler
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Sophie D Fossa
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Sarah L Kerns
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Chunkit Fung
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Howard D Sesso
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Patrick O Monahan
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Darren R Feldman
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Robert Hamilton
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - David J Vaughn
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Clair J Beard
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Amy Budnick
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Eileen M Johnson
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Shirin Ardeshir-Rouhani-Fard
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Lawrence H Einhorn
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI.
| | - Steven E Lipshultz
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - M Eileen Dolan
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Lois B Travis
- Robert D. Frisina, University of South Florida, Tampa, FL; Heather E. Wheeler, Loyola University Chicago; M. Eileen Dolan, University of Chicago, Chicago, IL; Sophie D. Fossa, Oslo University Hospital, Radiumhospital, Oslo, Norway; Sarah L. Kerns, Chunkit Fung, and Eileen M. Johnson, J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester; Darren R. Feldman and Amy Budnick, Memorial Sloan Kettering Cancer Center, New York, NY; Howard D. Sesso, Brigham and Women's Hospital; Clair J. Beard, Dana-Farber Cancer Institute, Boston, MA; Patrick O. Monahan, Shirin Ardeshir-Rouhani-Fard, Lawrence H. Einhorn, and Lois B. Travis, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Robert Hamilton, Princess Margaret Cancer Centre, Toronto, ON; David J. Vaughn, University of Pennsylvania, Philadelphia, PA; and Steven E. Lipshultz, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
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Spracklen TF, Vorster AA, Ramma L, Dalvie S, Ramesar RS. Promoter region variation in NFE2L2 influences susceptibility to ototoxicity in patients exposed to high cumulative doses of cisplatin. THE PHARMACOGENOMICS JOURNAL 2016; 17:515-520. [PMID: 27457817 DOI: 10.1038/tpj.2016.52] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/06/2016] [Accepted: 05/18/2016] [Indexed: 01/09/2023]
Abstract
Ototoxicity is a disabling reaction to cisplatin chemotherapy. Much of the inter-individual variability in the development of hearing impairment among cisplatin-receiving patients has not been fully accounted for. In particular, little is known about the pharmacogenomics of cisplatin-induced ototoxicity. This study sought to investigate the role of variation in five candidate genes in a cohort of South African cancer patients. Five variants within the candidate genes were genotyped in 214 patients, of which SLC22A2 rs316019 and NFE2L2 rs6721961 associated with reduced rates of ototoxicity. In the patients who were exposed to cumulative cisplatin doses ⩾200 mg m-2 (n=113), the variant rs6721961 associated with ototoxicity according to three different grading scales of hearing loss (ASHA, P=0.005; Chang, P=0.028; CTCAE, P=0.004). The NFE2L2 promotor variant rs6721961 may therefore be protective against hearing loss in cisplatin-receiving cancer patients.
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Affiliation(s)
- T F Spracklen
- MRC Human Genetics Research Unit, Division of Human Genetics, Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - A A Vorster
- MRC Human Genetics Research Unit, Division of Human Genetics, Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - L Ramma
- Division of Communication Sciences and Disorders, Groote Schuur Hospital, Cape Town, South Africa
| | - S Dalvie
- Department of Radiation Oncology, Groote Schuur Hospital, Cape Town, South Africa
| | - R S Ramesar
- MRC Human Genetics Research Unit, Division of Human Genetics, Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Lambert EM, Gunn GB, Gidley PW. Effects of radiation on the temporal bone in patients with head and neck cancer. Head Neck 2016; 38:1428-35. [PMID: 27453348 DOI: 10.1002/hed.24267] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/21/2015] [Accepted: 09/03/2015] [Indexed: 11/06/2022] Open
Abstract
Radiotherapy is a key component in the treatment of many head and neck cancers, and its potential to cause long-term adverse effects has become increasingly recognized. In this review, we describe the short-term and long-term sequelae of radiation-associated changes in and injury to the temporal bone and its related structures. The pathophysiology of radiation-induced injury and its clinical entities, including sensorineural hearing loss, chronic otitis media, osteoradionecrosis, and radiation-associated malignancies, are described. We also discuss radiation dose to the head and neck as it relates to these conditions. An improved understanding of radiation's effects on the temporal bone will enable physicians and researchers to continue efforts to reduce radiotherapy-related sequelae and guide clinicians in diagnosing and treating the various otologic conditions that can arise in patients with head and neck cancer who have received radiotherapy. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1428-1435, 2016.
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Affiliation(s)
- Elton M Lambert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Bass JK, Hua CH, Huang J, Onar-Thomas A, Ness KK, Jones S, White S, Bhagat SP, Chang KW, Merchant TE. Hearing Loss in Patients Who Received Cranial Radiation Therapy for Childhood Cancer. J Clin Oncol 2016; 34:1248-55. [PMID: 26811531 DOI: 10.1200/jco.2015.63.6738] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients treated with cranial radiation therapy (RT) are at risk for sensorineural hearing loss (SNHL). Although SNHL is often characterized as a delayed consequence of anticancer therapy, longitudinal reports of SNHL in childhood cancer survivors treated with contemporary RT are limited. We report the incidence, onset, severity, and long-term trajectory of SNHL among children receiving RT. Potential risk factors for SNHL were also identified. PATIENTS AND METHODS Serial audiologic testing was conducted on 235 pediatric patients who were treated with conformal or intensity-modulated RT as part of an institutional phase II trial for localized primary brain tumors, including craniopharyngioma, ependymoma, and juvenile pilocytic astrocytoma. All but one patient had measurable cochlear radiation dose (CRD) greater than 0 Gy. The median follow-up from RT initiation to latest audiogram was 9 years with a median of 11 post-RT audiograms per patient. Audiograms were classified by the Chang Ototoxicity Grading Scale. Progression was defined by an increase in Chang grade from SNHL onset to the most recent evaluation. RESULTS At last evaluation, SNHL was prevalent in 14% of patients: 2.1% had mild and 11.9% had significant SNHL requiring hearing aids. Median time from RT to SNHL onset was 3.6 years (range, 0.4 to 13.2 years). Among 29 patients with follow-up evaluations after SNHL onset, 65.5% experienced continued decline in hearing sensitivity in either ear and 34.5% had no change. Younger age at RT initiation (hazard ratio [HR], 2.32; 95% CI, 1.21 to 4.46), higher CRD (HR, 1.07; 95% CI, 1.03 to 1.11), and cerebrospinal fluid shunting (HR, 2.02; 95% CI, 1.07 to 3.78) were associated with SNHL. CONCLUSION SNHL is a late effect of RT that likely worsens over time. Long-term audiologic follow-up for a minimum of 10 years post-RT is recommended.
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Affiliation(s)
- Johnnie K Bass
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA.
| | - Chia-Ho Hua
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA
| | - Jie Huang
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA
| | - Arzu Onar-Thomas
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA
| | - Kirsten K Ness
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA
| | - Skye Jones
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA
| | - Stephanie White
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA
| | - Shaum P Bhagat
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA
| | - Kay W Chang
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA
| | - Thomas E Merchant
- Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA
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Wang J, Chen YY, Tai A, Chen XL, Huang SM, Yang C, Bao Y, Li NW, Deng XW, Zhao C, Chen M, Li XA. Sensorineural Hearing Loss after Combined Intensity Modulated Radiation Therapy and Cisplatin-Based Chemotherapy for Nasopharyngeal Carcinoma. Transl Oncol 2015; 8:456-62. [PMID: 26692526 PMCID: PMC4700287 DOI: 10.1016/j.tranon.2015.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The incidence of sensorineural hearing loss (SNHL) after treatment with combination of intensity-modulated radiation therapy (IMRT) and cisplatin-based chemotherapy in nasopharyngeal carcinoma (NPC) patients was evaluated, and relationships of SNHL with host factors, treatment-related factors, and radiation dosimetric parameters were investigated. METHODS Fifty-one NPC patients treated with IMRT from 2004 to 2009 were analyzed. All patients received neoadjuvant, concurrent, or adjuvant use of cisplatin. Pure tone audiometry was performed during the follow-up period with a median time of 60months, ranging from 28 to 84months. Correlation of SNHL at low frequencies (pure tone average, 0.5-2kHz) with a series of factors was analyzed. RESULTS Among 102 ears, 12.7% had low-frequency SNHL and 42.2% had high-frequency (4kHz) SNHL. The incidence of low-frequency SNHL was greater in patients with age>40, with T-stage 4, or who received cumulative cisplatin dose (CCD)>200mg/m(2) (P=.034, .011, and .003, respectively) and in ears with secretory otitis media (SOM) (P=.002). Several dosimetric parameters were found to be correlated with SNHL. Univariate analysis showed that the minimum radiation dose to 0.1ml highest dose volume (D0.1ml) of the cochlea was the best radiation-related predictive parameter. Multivariate analysis indicated that CCD, SOM, and D0.1ml of cochlea (P=.035, .012, and .022, respectively) were the factors associated with SNHL. CONCLUSION For NPC patients treated with IMRT and chemotherapy, the incidence of treatment-related SNHL was associated with CCD, D0.1ml of cochlea, and SOM.
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Affiliation(s)
- Jin Wang
- Departments of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Yuan-Yuan Chen
- Departments of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Xue-Lin Chen
- Department of Nasopharyngeal Carcinoma, Cancer Center, Sun Yat-sen University Guangzhou, People's Republic of China
| | - Shao-Ming Huang
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Cungen Yang
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Yong Bao
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ning-Wei Li
- Department of Nasopharyngeal Carcinoma, Cancer Center, Sun Yat-sen University Guangzhou, People's Republic of China
| | - Xiao-Wu Deng
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Chong Zhao
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Ming Chen
- Departments of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI.
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Abstract
Objective. To elucidate the incidence of cisplatin induced ototoxicity in adult patients, with a focus on an adult population. Study Design. IRB approved retrospective study. Methods. The charts of patients who underwent cisplatin therapy from 1995 to present were reviewed. Inclusion criteria were (1) cisplatin as the primary chemotherapeutic agent and (2) hearing evaluation performed prior to and after treatment. Audiometric thresholds were measured by presenting pure-tone stimuli at 0.25 to 10.0 kHz. Criteria for hearing loss were based on the Chang criteria. Cochlear radiation doses were also calculated in patients with primary tumors in their head and neck or brain. Results. There were 1565 patients that had undergone therapy with cisplatin from 1995 to 2014, which 30 met inclusion criteria. Eight were patients treated for head and neck or brain cancer. Evaluation with ANOVA testing identified statistically significant decline in audiometric scores for WRS and pure tone frequencies 500, 2000, 4000, 6000, and 8000 Hz in the right ear. Overall, hearing loss was noted with 63% incidence and in patients who received radiation to their cochlea and cisplatin. Conclusion. The incidence of cisplatin induced ototoxicity was significant and even more prevalent in those patients receiving both cisplatin and radiation to their cochlea.
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Brown AL, Lupo PJ, Okcu MF, Lau CC, Rednam S, Scheurer ME. SOD2 genetic variant associated with treatment-related ototoxicity in cisplatin-treated pediatric medulloblastoma. Cancer Med 2015; 4:1679-86. [PMID: 26400460 PMCID: PMC4673994 DOI: 10.1002/cam4.516] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/24/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022] Open
Abstract
Manganese superoxide dismutase (MnSOD), encoded by the SOD2 gene, is involved in the detoxification of superoxide anion. Superoxide is likely a source of oxidative stress in the cochlea following treatment with platinum agents and radiation. Therefore, we examined SOD2 variants in association with ototoxicity among cisplatin-treated childhood medulloblastoma patients. Blood samples were obtained from 71 eligible patients treated for pediatric medulloblastoma at Texas Children’s Cancer Center (1987–2010). Ototoxicity was defined as requiring the use of a hearing aid sometime after the initiation of therapy. DNA was genotyped on the Illumina HumanOmni-1 Quad BeadChip. A linkage disequilibrium (LD)-based single-nucleotide polymorphism (SNP) selection strategy was used to identify a minimal set of informative variants. Associations between SNPs and ototoxicity were assessed using logistic regression. Of the 71 eligible patients, 26 (37%) suffered from cisplatin-related ototoxicity. Study participants were primarily male (73%) and non-Hispanic white (42%). Five SOD2 variants (rs7855, rs5746151, rs5746136, rs2758331, and rs4880) identified by the LD-based selection strategy were genotyped. After correcting for multiple comparisons, the C-allele of the rs4880 variant was significantly associated with ototoxicity (odds ratio = 3.06, 95% confidence interval: 1.30–7.20) in adjusted models. The rs4880 T > C substitution results in a Val > Ala amino acid change at position 16 of the MnSOD mitochondrial targeting sequence. The Ala variant, which has been associated with increased MnSOD activity, was associated with hearing damage in this study. Platinum-based therapies increase the expression of MnSOD, which may result in an abundance of hydrogen peroxide, a reactive oxygen species. Therefore, oxidative stress may be an important mechanism in therapy-related cochlear damage.
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Affiliation(s)
- Austin L Brown
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Philip J Lupo
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Mehmet Fatih Okcu
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Ching C Lau
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Surya Rednam
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Michael E Scheurer
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
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Normal tissue complication probability modeling for cochlea constraints to avoid causing tinnitus after head-and-neck intensity-modulated radiation therapy. Radiat Oncol 2015; 10:194. [PMID: 26377924 PMCID: PMC4574090 DOI: 10.1186/s13014-015-0501-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 09/04/2015] [Indexed: 01/12/2023] Open
Abstract
Background Radiation-induced tinnitus is a side effect of radiotherapy in the inner ear for cancers of the head and neck. Effective dose constraints for protecting the cochlea are under-reported. The aim of this study is to determine the cochlea dose limitation to avoid causing tinnitus after head-and-neck cancer (HNC) intensity-modulated radiation therapy (IMRT). Methods In total 211 patients with HNC were included; the side effects of radiotherapy were investigated for 422 inner ears in the cohort. Forty-nine of the four hundred and twenty-two samples (11.6 %) developed grade 2+ tinnitus symptoms after IMRT, as diagnosed by a clinician. The Late Effects of Normal Tissues–Subjective, Objective, Management, Analytic (LENT-SOMA) criteria were used for tinnitus evaluation. The logistic and Lyman-Kutcher-Burman (LKB) normal tissue complication probability (NTCP) models were used for the analyses. Results The NTCP-fitted parameters were TD50 = 46.31 Gy (95 % CI, 41.46–52.50), γ50 = 1.27 (95 % CI, 1.02–1.55), and TD50 = 46.52 Gy (95 % CI, 41.91–53.43), m = 0.35 (95 % CI, 0.30–0.42) for the logistic and LKB models, respectively. The suggested guideline TD20 for the tolerance dose to produce a 20 % complication rate within a specific period of time was TD20 = 33.62 Gy (95 % CI, 30.15–38.27) (logistic) and TD20 = 32.82 Gy (95 % CI, 29.58–37.69) (LKB). Conclusions To maintain the incidence of grade 2+ tinnitus toxicity <20 % in IMRT, we suggest that the mean dose to the cochlea should be <32 Gy. However, models should not be extrapolated to other patient populations without further verification and should first be confirmed before clinical implementation.
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Long-term outcome of sensorineural hearing loss in nasopharyngeal carcinoma patients: comparison between treatment with radiotherapy alone and chemoradiotherapy. Cell Biochem Biophys 2015; 69:433-7. [PMID: 24510513 DOI: 10.1007/s12013-014-9814-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study is to assess the long-term effect of sensorineural hearing loss (SNHL) resulted from radiotherapy (RT) alone versus chemoradiotherapy in nasopharyngeal carcinoma patients (NPC). Seventy-two patients initially diagnosed with NPC were enrolled from Shandong Tumor Hospital between March 2003 and May 2007. They were assigned into two groups: RT alone and chemoradiotherapy according to the different treatment regimens. Intensity-modulated radiation therapy was applied for both groups, concurrent and adjuvant cisplatin were administered for chemoradiotherapy group additionally. Hearing threshold test was performed at various time periods after completion of RT. Mean radiation dose to the cochlea in each ear was calculated to determine the correlation between cochlear dose and SNHL. We found that the hearing loss is more severe in the chemoradiotherapy group compared with RT group, from completion of RT up to the 5 years of follow-up period. This is especially obvious in the high frequency range. Hearing level is seriously damaged when cochlea dose exceeds 46 GY. We concluded that concurrent/adjuvant chemotherapy plus RT aggravates SNHL in NPC patients than RT alone and thus inner ear tissue tolerance should be redefined in those patients.
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Spracklen TF, Whitehorn H, Vorster AA, Ramma L, Dalvie S, Ramesar RS. Genetic variation in Otos is associated with cisplatin-induced ototoxicity. Pharmacogenomics 2015; 15:1667-76. [PMID: 25410892 DOI: 10.2217/pgs.14.112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Ototoxicity is an adverse drug reaction that may limit the effective use of cisplatin chemotherapy. Given the reported in vitro protective role of the gene Otos in response to cisplatin, this study aimed to explore the potential of Otos as a genetic modifier of ototoxicity. PATIENTS & METHODS One hundred South African cisplatin-receiving cancer patients with baseline and follow-up audiometric data were screened for variation in exonic target regions of Otos using direct cycle sequencing. RESULTS A total of 29 genetic variants were identified. The G alleles of Otos rs77124181 (c.-192-182C>G) and rs2291767 (c.-192-22A>G) were over-represented in ototoxicity-free patients (p = 0.022). Cumulative cisplatin dose and anatomical site of cancer were also associated with ototoxicity, while self-reported ethnicity associated with the ototoxic severity. CONCLUSION This study indicates a potentially protective role for the variant G alleles of SNPs rs77124181 and rs2291767 in Otos against the development of cisplatin-induced ototoxicity.
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Affiliation(s)
- Timothy F Spracklen
- MRC Human Genetics Research Unit, Division of Human Genetics, Institute of Infectious Diseases & Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Hearing Assessment after Treatment of Nasopharyngeal Carcinoma with CRT and IMRT Techniques. BIOMED RESEARCH INTERNATIONAL 2015; 2015:769806. [PMID: 26351638 PMCID: PMC4553178 DOI: 10.1155/2015/769806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/17/2015] [Accepted: 08/02/2015] [Indexed: 11/17/2022]
Abstract
Objectives. This study analyzed the long-term hearing loss after treatment of primary nasopharyngeal carcinoma to elucidate its causal factors. Methods. Ninety-two nasopharyngeal carcinoma patients were treated with radiotherapy or chemoradiotherapy. Pure tone audiometry was performed before the therapy and annually up to 9 years after completing treatment. The hearing thresholds were corrected for age-related deterioration and compared to the results without adjusting for age. Results. The mean air and bone conduction threshold with and without correction for age-related deterioration differed significantly 2–9 years after completing radiotherapy (p < 0.05). The audiometry results with age correction showed a flattened configuration compared to the results without age correction. The total radiation dose and radiation modality showed a causal relationship with a greater incidence of hearing loss after therapy (p < 0.05). There was more deterioration in the air and bone hearing thresholds with conformal radiotherapy than intensity-modulated radiotherapy (p < 0.001). A radiation dose >72 cGy resulted in more severe hearing loss than <72 cGy (p < 0.05). Conclusion. Hearing loss after completing therapy should be corrected for age-related hearing deterioration to reveal the true extent to which the loss is a therapeutic complication. Both the radiation modality used and the dose were significantly associated with hearing loss.
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Callejo A, Sedó-Cabezón L, Juan ID, Llorens J. Cisplatin-Induced Ototoxicity: Effects, Mechanisms and Protection Strategies. TOXICS 2015; 3:268-293. [PMID: 29051464 PMCID: PMC5606684 DOI: 10.3390/toxics3030268] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 12/11/2022]
Abstract
Cisplatin is a highly effective chemotherapeutic agent that is widely used to treat solid organ malignancies. However, serious side effects have been associated with its use, such as bilateral, progressive, irreversible, dose-dependent neurosensory hearing loss. Current evidence indicates that cisplatin triggers the production of reactive oxygen species in target tissues in the inner ear. A variety of agents that protect against cisplatin-induced ototoxicity have been successfully tested in cell culture and animal models. However, many of them interfere with the therapeutic effect of cisplatin, and therefore are not suitable for systemic administration in clinical practice. Consequently, local administration strategies, namely intratympanic administration, have been developed to achieve otoprotection, without reducing the antitumoral effect of cisplatin. While a considerable amount of pre-clinical information is available, clinical data on treatments to prevent cisplatin ototoxicity are only just beginning to appear. This review summarizes clinical and experimental studies of cisplatin ototoxicity, and focuses on understanding its toxicity mechanisms, clinical repercussions and prevention strategies.
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Affiliation(s)
- Angela Callejo
- Unitat Funcional d'Otorrinolaringologia i Al·lèrgia, Institut Universtiari Quirón Dexeus, 08028 Barcelona, Catalonia, Spain.
| | - Lara Sedó-Cabezón
- Departament de Ciències Fisiològiques II, Universitat de Barcelona, 08907 L'Hospitalet de Llobregat, Catalonia, Spain.
| | - Ivan Domènech Juan
- Unitat Funcional d'Otorrinolaringologia i Al·lèrgia, Institut Universtiari Quirón Dexeus, 08028 Barcelona, Catalonia, Spain.
- Servei d'Otorrinolaringologia, Hospital Universitario de Bellvitge, 08907 L'Hospitalet de Llobregat, Catalonia, Spain.
| | - Jordi Llorens
- Departament de Ciències Fisiològiques II, Universitat de Barcelona, 08907 L'Hospitalet de Llobregat, Catalonia, Spain.
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Catalonia, Spain.
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Sensorineural hearing loss following induction chemotherapy plus concurrent chemoradiotherapy for advanced nasopharyngeal carcinoma. The Journal of Laryngology & Otology 2015; 129:767-72. [PMID: 26112091 DOI: 10.1017/s0022215115001632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the incidence of sensorineural hearing loss between those treated with docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by carboplatin concurrent chemoradiotherapy and those treated with conventional concurrent chemoradiotherapy for advanced nasopharyngeal carcinoma. METHODS Serial pure tone audiometry was conducted in 36 nasopharyngeal carcinoma patients who were randomised into 2 groups. The first group received docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by carboplatin concurrent chemoradiotherapy. The second group received conventional concurrent chemoradiotherapy. RESULTS The incidence of sensorineural hearing loss at speech frequency in the first group was 10 per cent and in the second group was 50 per cent (p = 0.0027). Bone conduction thresholds were significantly increased after completion of the treatment at 2-4 kHz in the first group and at all frequencies in the second group. CONCLUSION The docetaxel, cisplatin and 5-fluorouracil induction chemotherapy regimen followed by concurrent chemoradiotherapy was associated with a lower incidence of sensorineural hearing loss than conventional concurrent chemoradiotherapy. This regimen may be the preferred choice of treatment for hearing preservation.
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Xu H, Robinson GW, Huang J, Lim JYS, Zhang H, Bass JK, Broniscer A, Chintagumpala M, Bartels U, Gururangan S, Hassall T, Fisher M, Cohn R, Yamashita T, Teitz T, Zuo J, Onar-Thomas A, Gajjar A, Stewart CF, Yang JJ. Common variants in ACYP2 influence susceptibility to cisplatin-induced hearing loss. Nat Genet 2015; 47:263-6. [PMID: 25665007 PMCID: PMC4358157 DOI: 10.1038/ng.3217] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/14/2015] [Indexed: 02/05/2023]
Abstract
Taking a genome-wide association study approach, we identified inherited genetic variations in ACYP2 associated with cisplatin-related ototoxicity (rs1872328: P = 3.9 × 10(-8), hazard ratio = 4.5) in 238 children with newly diagnosed brain tumors, with independent replication in 68 similarly treated children. The ACYP2 risk variant strongly predisposed these patients to precipitous hearing loss and was related to ototoxicity severity. These results point to new biology underlying the ototoxic effects of platinum agents.
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Affiliation(s)
- Heng Xu
- 1] Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. [2] Department of Laboratory Medicine, National Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Giles W Robinson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jie Huang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Joshua Yew-Suang Lim
- 1] Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. [2] Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Zhang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Johnnie K Bass
- Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Alberto Broniscer
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Ute Bartels
- Department of Haematology and Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sri Gururangan
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Tim Hassall
- Department of Oncology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Michael Fisher
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richard Cohn
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Tetsuji Yamashita
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Tal Teitz
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jian Zuo
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Clinton F Stewart
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jun J Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Zhang J, Qureshi MM, Kovalchuk N, Truong MT. Correlating planned radiation dose to the cochlea with primary site and tumor stage in patients with head and neck cancer treated with intensity-modulated radiation therapy. Med Dosim 2014; 39:88-92. [PMID: 24485054 DOI: 10.1016/j.meddos.2013.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 09/09/2013] [Accepted: 10/27/2013] [Indexed: 12/01/2022]
Abstract
The aim of the study was to determine tumor characteristics that predict higher planned radiation (RT) dose to the cochlea in patients with head and neck cancer (HNC) treated with intensity-modulated radiotherapy (IMRT). From 2004 to 2012, 99 patients with HNC underwent definitive IMRT to a median dose of 69.96Gy in 33 fractions, with the right and left cochlea-vestibular apparatus contoured for IMRT optimization as avoidance structures. If disease involvement was adjacent to the cochlea, preference was given to tumor coverage by prescription dose. Descriptive statistics were calculated for dose-volume histogram planning data, and mean planning dose to the cochlea (from left or right cochlea, receiving the greater amount of RT dose) was correlated to primary site and tumor stage. Mean (standard deviation) cochlear volume was 1.0 (0.60)cm(3) with maximum and mean planned doses of 31.9 (17.5)Gy and 22.1 (13.7)Gy, respectively. Mean planned dose (Gy) to cochlea by tumor site was as follows: oral cavity (18.6, 14.4), oropharynx (21.7, 9.1), nasopharynx (36.3, 10.4), hypopharynx (14.9, 7.1), larynx (2.1, 0.62), others including the parotid gland, temporal bone, and paranasal sinus (33.6, 24.0), and unknown primary (25.6, 6.7). Average mean planned dose (Gy) to the cochlea in T0-T2 and T3-T4 disease was 22.0 and 29.2Gy, respectively (p = 0.019). By site, a significant difference was noted for nasopharynx and others (31.6 and 50.7, p = 0.012) but not for oropharynx, oral cavity, and hypopharynx. Advanced T category predicted for higher mean cochlear dose, particularly for nasopharyngeal, parotid gland, temporal bone, and paranasal sinus HNC sites.
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Affiliation(s)
- Jeanette Zhang
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, MA
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, MA
| | - Nataliya Kovalchuk
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, MA
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, MA.
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