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Burger AVM, Duinkerken CW, van Sluis KE, de Boer JP, Navran A, Lanting CP, Jóźwiak K, Dreschler WA, Balm AJM, Zuur CL. Treatment-related hearing loss in weekly versus triweekly cisplatin chemoradiation for head and neck cancer. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08880-x. [PMID: 39242413 DOI: 10.1007/s00405-024-08880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/29/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Cisplatin-induced hearing loss is a common side effect in patients treated with cisplatin-based chemoradiation (CRT) for head and neck squamous cell carcinoma. The extent of hearing loss after concurrent CRT was compared between triweekly (3 × 100 mg/m2) and weekly (7 × 40 mg/m2) cisplatin CRT. METHOD This retrospective cohort study was conducted in the Antoni van Leeuwenhoek Hospital and included 129 patients with cisplatin-based CRT for head and neck cancer (72 treated in the triweekly and 57 in the weekly regimen). Baseline and follow-up pure tone audiometry was conducted to assess hearing loss. Clinically relevant hearing loss was defined as a decline upon treatment of ≥ 10 decibel at a pure tone average 1-2-4 kHz and/or 8-10-12.5 kHz. RESULTS The incidence of clinically relevant cisplatin CRT induced hearing loss was 42% in the triweekly versus 19% in the weekly group (p < 0.01). The mean threshold shift at a pure tone average (PTA) 1-2-4 kHz was 9.0 decibel in the triweekly compared to 4.3 decibel in the weekly CRT group (p < 0.01). At PTA 8-10-12.5 kHz, the incidence of clinically relevant hearing loss was 75% in the triweekly compared to 74% in the weekly CRT group (p = 0.87). The mean threshold shift at PTA 8-10-12.5 kHz was 20.2 decibel versus 15.6 decibel, respectively (p = 0.07). CONCLUSION Cisplatin-dose reduction to a weekly cisplatin CRT regimen for head and neck cancer may reduce the incidence of clinically relevant hearing loss at frequencies vital for speech perception.
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Affiliation(s)
- A V M Burger
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
- Department of Otolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - C W Duinkerken
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
- Department of Otolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - K E van Sluis
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
| | - J P de Boer
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Navran
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C P Lanting
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - W A Dreschler
- Department of Audiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - A J M Balm
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands
- Department of Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - C L Zuur
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.
- Department of Otolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
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2
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Schaeffers AWMA, Burger AVM, Duinkerken CW, van Sluis KE, de Boer JP, van der Molen L, Hoetink AE, Al-Mamgani A, Jóźwiak K, Devriese LA, de Bree R, Zuur CL. The association between skeletal muscle mass and sensorineural hearing loss upon cisplatin-based chemoradiotherapy in patients with head and neck squamous cell carcinoma. Head Neck 2024. [PMID: 39096016 DOI: 10.1002/hed.27907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/05/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Patients with head and neck squamous cell carcinoma (HNSCC) treated with cisplatin-based chemoradiotherapy (CRT) frequently experience irreversible sensorineural hearing loss (SNHL). Patients with low lumbar skeletal muscle index (LSMI) may experience higher serum peak dosages of cisplatin. This study investigated whether pre-treatment low LSMI is associated with increased SNHL upon cisplatin-based CRT. MATERIALS AND METHODS LSMI was assessed using routine pre-treatment CT scans. Pure tone audiometry was performed at baseline and at follow-up to assess treatment-related SNHL. Linear mixed models were used to reveal a potential association between the continuous variable LSMI and SNHL. RESULTS This retrospective cohort study included 81 patients and found a significant association between low LSMI and increased treatment-related SNHL at pure tone frequencies vital for the perception of speech (averaged of 1, 2, and 4 kHz) (p = 0.048). CONCLUSIONS HNSCC patients with low LSMI suffer increased treatment-related SNHL upon cisplatin-based CRT.
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Affiliation(s)
- Anouk W M A Schaeffers
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anouk V M Burger
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Otolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Charlotte W Duinkerken
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Otolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Klaske E van Sluis
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alex E Hoetink
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, UMC Brain Centre, Utrecht, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Lot A Devriese
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Charlotte L Zuur
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Otolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
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3
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Meijer AJ, Diepstraten FA, Ansari M, Bouffet E, Bleyer A, Fresneau B, Geller JI, Huitema AD, Kogner P, Maibach R, O'Neill AF, Papadakis V, Rajput KM, Veal GJ, Sullivan M, van den Heuvel-Eibrink MM, Brock PR. Use of Sodium Thiosulfate as an Otoprotectant in Patients With Cancer Treated With Platinum Compounds: A Review of the Literature. J Clin Oncol 2024; 42:2219-2232. [PMID: 38648563 PMCID: PMC11191063 DOI: 10.1200/jco.23.02353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/05/2024] [Accepted: 02/07/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Hearing loss occurs in 50%-70% of children treated with cisplatin. Scientific efforts have led to the recent approval of a pediatric formula of intravenous sodium thiosulfate (STS) for otoprotection by the US Food and Drug Administration, the European Medicines Agency, and the Medicines and Health Regulatory Authority in the United Kingdom. To inform stakeholders regarding the clinical utility of STS, the current review summarizes available literature on the efficacy, pharmacokinetics (PK), and safety of systemic STS to minimize cisplatin-induced hearing loss (CIHL). DESIGN A comprehensive narrative review is presented. RESULTS Thirty-one articles were summarized. Overall, systemic STS effectively reduces CIHL in the preclinical and controlled clinical study settings, in both adults and children with cancer. The extent of CIHL reduction depends on the timing and dosing of STS in relation to cisplatin. Both preclinical and clinical data suggest that systemic STS may affect plasma platinum levels, but studies are inconclusive. Delayed systemic administration of STS, at 6 hours after the cisplatin infusion, does not affect cisplatin-induced inhibition of tumor growth or cellular cytotoxicity in the preclinical setting, nor affect cisplatin efficacy and survival in children with localized disease in the clinical setting. CONCLUSION Systemic administration of STS effectively reduces the development and degree of CIHL in both the preclinical and clinical settings. More studies are needed on the PK of STS and cisplatin drug combinations, the efficacy and safety of STS in patients with disseminated disease, and the ability of STS to prevent further deterioration of pre-established hearing loss.
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Affiliation(s)
| | | | - Marc Ansari
- Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Geneva Hospitals, Geneva, Switzerland
| | - Eric Bouffet
- Division of Pediatric Neuro-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Archie Bleyer
- Department of Radiation Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, Canada
| | - Brice Fresneau
- Department of Children and Adolescents Oncology, Gustave Roussy, University Paris Saclay and Radiation Epidemiology Team, CESO, Inserm U1018, Villejuif, France
| | - James I. Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Alwin D.R. Huitema
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Per Kogner
- Department of Pediatric Oncology and Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | | | - Allison F. O'Neill
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Vassilios Papadakis
- Department of Pediatric Hematology-Oncology (TAO), Agia Sofia Children's Hospital, Athens, Greece
| | - Kaukab M. Rajput
- Department of Pediatric Audiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Gareth J. Veal
- Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Sullivan
- Children's Cancer Centre and Department of Pediatric Oncology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Wilhelmina Childrens' Hospital, Division of Child Health, Utrecht, the Netherlands
| | - Penelope R. Brock
- Department of Pediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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4
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Kappel AD, Jha R, Guggilapu S, Smith WJ, Feroze AH, Dmytriw AA, Vicenty-Padilla J, Alcedo Guardia RE, Gessler FA, Patel NJ, Du R, See AP, Peruzzi PP, Aziz-Sultan MA, Bernstock JD. Endovascular Applications for the Management of High-Grade Gliomas in the Modern Era. Cancers (Basel) 2024; 16:1594. [PMID: 38672676 PMCID: PMC11049132 DOI: 10.3390/cancers16081594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
High-grade gliomas (HGGs) have a poor prognosis and are difficult to treat. This review examines the evolving landscape of endovascular therapies for HGGs. Recent advances in endovascular catheter technology and delivery methods allow for super-selective intra-arterial cerebral infusion (SSIACI) with increasing precision. This treatment modality may offer the ability to deliver anti-tumoral therapies directly to tumor regions while minimizing systemic toxicity. However, challenges persist, including blood-brain barrier (BBB) penetration, hemodynamic complexities, and drug-tumor residence time. Innovative adjunct techniques, such as focused ultrasound (FUS) and hyperosmotic disruption, may facilitate BBB disruption and enhance drug penetration. However, hemodynamic factors that limit drug residence time remain a limitation. Expanding therapeutic options beyond chemotherapy, including radiotherapy and immunobiologics, may motivate future investigations. While preclinical and clinical studies demonstrate moderate efficacy, larger randomized trials are needed to validate the clinical benefits. Additionally, future directions may involve endovascular sampling for peri-tumoral surveillance; changes in drug formulations to prolong residence time; and the exploration of non-pharmaceutical therapies, like radioembolization and photodynamic therapy. Endovascular strategies hold immense potential in reshaping HGG treatment paradigms, offering targeted and minimally invasive approaches. However, overcoming technical challenges and validating clinical efficacy remain paramount for translating these advancements into clinical care.
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Affiliation(s)
- Ari D. Kappel
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Rohan Jha
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
| | - Saibaba Guggilapu
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
| | - William J. Smith
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Abdullah H. Feroze
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Adam A. Dmytriw
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Juan Vicenty-Padilla
- Neurosurgery Section, School of Medicine University of Puerto Rico, Medical Sciences Campus, San Juan P.O. Box 365067, Puerto Rico (R.E.A.G.)
| | - Rodolfo E. Alcedo Guardia
- Neurosurgery Section, School of Medicine University of Puerto Rico, Medical Sciences Campus, San Juan P.O. Box 365067, Puerto Rico (R.E.A.G.)
| | - Florian A. Gessler
- Department of Neurosurgery, Rostock University Hospital, 18057 Rostock, Germany
| | - Nirav J. Patel
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Rose Du
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Alfred P. See
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Pier Paolo Peruzzi
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Mohammad A. Aziz-Sultan
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Joshua D. Bernstock
- Harvard Medical School, Boston, MA 02115, USA; (A.D.K.); (S.G.); (R.D.); (A.P.S.)
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
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5
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Qiao Y, Xiong M, Zhang YJ, Tsappidi S, Kan P, Weiss CR, Hui F, Chen SR. Current and future directions in interventional neuro-oncology-are we there yet? J Neurointerv Surg 2024:jnis-2024-021540. [PMID: 38637150 DOI: 10.1136/jnis-2024-021540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
Advancements in technology and technical expertise increasingly enable neurointerventionalists to deliver safer and more effective endovascular treatments to cancers of the brain, spine, head, and neck. In addition to established neuro-oncological interventions such as pre-surgical tumor embolization and percutaneous ablation, newer modalities focused on direct arterial infusion of chemotherapy, radioisotopes, and radiosensitizers continue to gain traction as complementary treatment options, while stem cell-mediated delivery of theranostic nanoparticles and oncolytic virus are being explored for even greater specificity in targeting cancers across the blood-brain barrier. This article aims to provide an overview of the current state of the art and future directions for the field of interventional neuro-oncology, as well as opportunities and challenges presented by this emerging treatment modality.
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Affiliation(s)
- Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maggie Xiong
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yi Jonathan Zhang
- Department of Neurointerventional Surgery, The Queen's Health Systems, Honolulu, Hawaii, USA
| | - Samuel Tsappidi
- Department of Neurointerventional Surgery, The Queen's Health Systems, Honolulu, Hawaii, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Clifford R Weiss
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
| | - Ferdinand Hui
- Department of Neurointerventional Surgery, The Queen's Health Systems, Honolulu, Hawaii, USA
| | - Stephen R Chen
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Gill NB, Dowker-Key PD, Hedrick M, Bettaieb A. Unveiling the Role of Oxidative Stress in Cochlear Hair Cell Death: Prospective Phytochemical Therapeutics against Sensorineural Hearing Loss. Int J Mol Sci 2024; 25:4272. [PMID: 38673858 PMCID: PMC11050722 DOI: 10.3390/ijms25084272] [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: 01/23/2024] [Revised: 03/31/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Hearing loss represents a multifaceted and pervasive challenge that deeply impacts various aspects of an individual's life, spanning psychological, emotional, social, and economic realms. Understanding the molecular underpinnings that orchestrate hearing loss remains paramount in the quest for effective therapeutic strategies. This review aims to expound upon the physiological, biochemical, and molecular aspects of hearing loss, with a specific focus on its correlation with diabetes. Within this context, phytochemicals have surfaced as prospective contenders in the pursuit of potential adjuvant therapies. These compounds exhibit noteworthy antioxidant and anti-inflammatory properties, which hold the potential to counteract the detrimental effects induced by oxidative stress and inflammation-prominent contributors to hearing impairment. Furthermore, this review offers an up-to-date exploration of the diverse molecular pathways modulated by these compounds. However, the dynamic landscape of their efficacy warrants recognition as an ongoing investigative topic, inherently contingent upon specific experimental models. Ultimately, to ascertain the genuine potential of phytochemicals as agents in hearing loss treatment, a comprehensive grasp of the molecular mechanisms at play, coupled with rigorous clinical investigations, stands as an imperative quest.
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Affiliation(s)
- Nicholas B. Gill
- Department of Nutrition, University of Tennessee Knoxville, Knoxville, TN 37996-0840, USA
| | - Presley D. Dowker-Key
- Department of Nutrition, University of Tennessee Knoxville, Knoxville, TN 37996-0840, USA
| | - Mark Hedrick
- Department of Audiology & Speech Pathology, The University of Tennessee Health Science Center, Knoxville, TN 37996-0240, USA
| | - Ahmed Bettaieb
- Department of Nutrition, University of Tennessee Knoxville, Knoxville, TN 37996-0840, USA
- Graduate School of Genome Science and Technology, University of Tennessee Knoxville, Knoxville, TN 37996-0840, USA
- Department of Biochemistry, Cellular and Molecular Biology, University of Tennessee Knoxville, Knoxville, TN 37996-0840, USA
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7
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Correa-Morales JE, Giraldo-Moreno S, Mantilla-Manosalva N, Cuellar-Valencia L, Borja-Montes OF, Bedoya-Muñoz LJ, Iriarte-Aristizábal MF, Quintero-Muñoz E, Zuluaga-Liberato AM. Prevention and treatment of cisplatin-induced ototoxicity in adults: A systematic review. Clin Otolaryngol 2024; 49:1-15. [PMID: 37818931 DOI: 10.1111/coa.14106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/04/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Ototoxicity is a common disabling side effect of platinum-based chemotherapy. This study aimed to assess the evidence on the management of platinum-induced ototoxicity in adult cancer patients. METHODS Four databases were searched up to 1 November 2022. Original studies were included if they reported on a pharmacologic or non-pharmacologic intervention to prevent or treat platinum ototoxicity in adults. The articles' quality was assessed via two grading scales. RESULTS Nineteen randomised controlled trials and five quasi-experimental studies with 1673 patients were analysed. Eleven interventions were identified, nine pharmacological and two non-pharmacological. Six of the interventions (sodium thiosulphate, corticoids, sertraline, statins, multivitamins and D-methionine) showed mild benefits in preventing cisplatin-induced ototoxicity. Only one trial assessed corticoids as a potential treatment. Overall, only six trials were deemed with a low risk of bias. The majority of studies inadequately documented intervention-related adverse effects, thereby limiting safety conclusions. CONCLUSIONS Current interventions have mild benefits in preventing cisplatin-induced ototoxicity in adult cancer patients. Sodium thiosulphate is the most promising intervention as a preventive strategy. Rigorous, high-quality research is warranted, encompassing an evaluation of all potential symptoms and innovative treatment modalities.
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Affiliation(s)
- Juan Esteban Correa-Morales
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Nidia Mantilla-Manosalva
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Laura Cuellar-Valencia
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Lennis Jazmin Bedoya-Muñoz
- Palliative Care Program, Universidad de La Sabana, Bogotá, Colombia
- Instituto Nacional de Cancerología, Bogotá, Colombia
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8
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Pandav R, Yadav V, Bhagat S, Sharma DK. Ototoxicity in Patients of Advanced Head and Neck Malignancies Receiving Chemoradiation Versus Radiation Alone: Comparative Study. Indian J Otolaryngol Head Neck Surg 2022; 74:3927-3932. [PMID: 36742606 PMCID: PMC9895734 DOI: 10.1007/s12070-021-02754-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/04/2021] [Indexed: 02/07/2023] Open
Abstract
To evaluate ototoxicity in patients receiving combined cisplatin and radiotherapy in comparison to patients receiving radiotherapy alone. A prospective study was conducted in sixty (60) cases of advanced Head and Neck malignancy (stage III and IV). Patient were divided in two randomized groups (30 each), group I received chemoradiation and group II received radiation alone. Inclusion criteria were histopathologically confirmed head & neck malignancy, normal baseline audiograms. Exclusion criteria were defined as: previously treated cases with chemotherapy/radiotherapy, patients who didn't complete treatment or lost to follow up. Ototoxicity was evaluated as per criterion established by the American speech-language-hearing association. Study participants were evaluated for ototoxicity at intervals defined as per study design. Sensorineural hearing loss (SNHL) was noticed in 56.6% and 36.6% of subjects in Group I & II respectively at 6 months follow up post completion of treatment. Incidence of sensorineural hearing loss increased significantly with cumulative dosages of chemoradiotherapy in group I and radiotherapy in group II. Incidence of SNHL in both study groups was found to be higher in patients older than 50 years. Incidence of ototoxicity in chemoradiated patients was found to be higher in comparison to patients receiving radiation alone. Ototoxicity occurred more with cumulative doses, with higher speech frequencies affected earlier in comparison to middle range frequencies. Lower frequencies were spared.
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Affiliation(s)
- Richa Pandav
- Department of ENT, Government Medical College and Rajindra Hospital, Patiala, Punjab 147001 India
| | - Vishav Yadav
- Department of ENT, Government Medical College and Rajindra Hospital, Patiala, Punjab 147001 India
| | - Sanjeev Bhagat
- Department of ENT, Government Medical College and Rajindra Hospital, Patiala, Punjab 147001 India
| | - Dinesh Kumar Sharma
- Department of ENT, Government Medical College and Rajindra Hospital, Patiala, Punjab 147001 India
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9
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Liu SS, Yang R. Inner Ear Drug Delivery for Sensorineural Hearing Loss: Current Challenges and Opportunities. Front Neurosci 2022; 16:867453. [PMID: 35685768 PMCID: PMC9170894 DOI: 10.3389/fnins.2022.867453] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/02/2022] [Indexed: 12/20/2022] Open
Abstract
Most therapies for treating sensorineural hearing loss are challenged by the delivery across multiple tissue barriers to the hard-to-access anatomical location of the inner ear. In this review, we will provide a recent update on various pharmacotherapy, gene therapy, and cell therapy approaches used in clinical and preclinical studies for the treatment of sensorineural hearing loss and approaches taken to overcome the drug delivery barriers in the ear. Small-molecule drugs for pharmacotherapy can be delivered via systemic or local delivery, where the blood-labyrinth barrier hinders the former and tissue barriers including the tympanic membrane, the round window membrane, and/or the oval window hinder the latter. Meanwhile, gene and cell therapies often require targeted delivery to the cochlea, which is currently achieved via intra-cochlear or intra-labyrinthine injection. To improve the stability of the biomacromolecules during treatment, e.g., RNAs, DNAs, proteins, additional packing vehicles are often required. To address the diverse range of biological barriers involved in inner ear drug delivery, each class of therapy and the intended therapeutic cargoes will be discussed in this review, in the context of delivery routes commonly used, delivery vehicles if required (e.g., viral and non-viral nanocarriers), and other strategies to improve drug permeation and sustained release (e.g., hydrogel, nanocarriers, permeation enhancers, and microfluidic systems). Overall, this review aims to capture the important advancements and key steps in the development of inner ear therapies and delivery strategies over the past two decades for the treatment and prophylaxis of sensorineural hearing loss.
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Affiliation(s)
- Sophie S. Liu
- Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY, United States
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
| | - Rong Yang
- Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY, United States
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
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10
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Dolezal JM, Rosenberg AJ. Induction Chemotherapy in Low-Risk HPV+ Oropharyngeal Cancer. Curr Treat Options Oncol 2022; 23:54-67. [PMID: 35171457 PMCID: PMC9619415 DOI: 10.1007/s11864-022-00941-9] [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] [Accepted: 10/08/2021] [Indexed: 12/08/2022]
Abstract
OPINION STATEMENT Human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing in incidence, and has now become the most common head and neck cancer (HNC). Studies have demonstrated that HPV associated OPSCC is associated with a favorable prognosis compared with its HPV-negative counterparts, yet standard multimodality therapy is often associated with substantial acute and late treatment-related toxicity. While locoregional control is improved in HPV+ OPSCC, distant metastasis rate has gained recognition as a major cause of death in this population, with some studies suggesting similar rates as non-HPV-related cancers. Induction chemotherapy has been of long-standing interest in locoregionally advanced HNC, yet its use in combination with concomitant chemoradiation remains an area of controversy as a survival benefit remains unproven following randomized trials. Nevertheless, response to induction chemotherapy remains an important dynamic and prognostic biomarker, with response-adaptive de-intensified therapy in HPV+ OPSCC gaining traction in single-arm phase II studies demonstrating promising results. The emergence of immunotherapy in the recurrent/metastatic setting for HNC has led to enthusiasm to incorporate in the curative setting, yet its role remains undefined. Our institutional paradigm for HPV+ OPSCC incorporates induction therapy followed by risk and response adaptive locoregional treatment. Ultimately, the role of induction therapy in HPV+ OPSCC will need to be investigated in a randomized setting to be incorporated routinely into clinical practice.
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Affiliation(s)
- James M Dolezal
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, 5841 S. Maryland Ave., MC 2115, Chicago, IL, 60637, USA
| | - Ari J Rosenberg
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, 5841 S. Maryland Ave., MC 2115, Chicago, IL, 60637, USA.
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11
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Evaluating the Efficacy of Intratympanic Dexamethasone in Protecting Against Irreversible Hearing Loss in Patients on Cisplatin-Based Cancer Treatment: A Randomized Controlled Phase IIIB Clinical Trial. Ear Hear 2021; 43:676-684. [PMID: 34483247 DOI: 10.1097/aud.0000000000001119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the efficacy of long-term high-dose intratympanic dexamethasone in protecting the hearing capacity of cancer patients undergoing cisplatin-based ototoxic treatment. DESIGN A randomized controlled phase IIIB clinical trial to evaluate the efficacy of dexamethasone in protecting against hearing loss in patients undergoing cisplatin treatment. The subjects participating in the clinical trial were patients with a neoplastic disease whose treatment protocol included cisplatin. The average dose of cisplatin was 444.87 mg (SD 235.2 mg). Treatment consisted of intratympanically administering dexamethasone via a passive diffusion device called Microwick (8 mg/24 h dose) from the start of treatment with cisplatin to 3 weeks after the last cycle. Patients were administered the medication to one ear, and the contralateral ear was used as the control. The treated ears were randomly chosen using a computer system (randomization). The hearing threshold was evaluated using pure tone audiometry before each cisplatin cycle. RESULTS Thirty-four patients were recruited over a 2-year period at a reference tertiary hospital, of whom 11 were excluded. Forty-six ears were analyzed (23 treated and 23 control ears). When treatment was completed, the audiometric analysis showed a higher hearing threshold in the study group than in the control group. Differences were statistically significant at frequencies of 500, 1000, and 6000 Hz: 4.9 dB (1.1 to 8.7), 5.5 dB (0.8 to 10.3), and 16 dB (3.2 to 28.7), respectively, (p < 0.05, 95% confidence interval), but were not clinically significant according to the ASHA hearing loss criteria. Both 8.69% infection complications during treatment and 34.8% permanent perforation at 6 mo were detected after device removal. CONCLUSIONS Long-term high-dose intratympanic dexamethasone treatment did not prevent cisplatin-induced hearing loss.
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12
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Wotman MT, Miles BA, Bakst RL, Posner MR. A proposal for risk-based and strategy-adapted de-escalation in human papillomavirus-positive oropharyngeal squamous cell carcinoma. Cancer 2021; 127:4330-4338. [PMID: 34379804 DOI: 10.1002/cncr.33851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Michael T Wotman
- The Department of Internal Medicine in the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett A Miles
- The Department of Otolaryngology in the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L Bakst
- The Department of Radiation Oncology in the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall R Posner
- The Department of Hematology/Oncology in the Icahn School of Medicine at Mount Sinai, New York, New York
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13
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Duinkerken CW, de Weger VA, Dreschler WA, van der Molen L, Pluim D, Rosing H, Nuijen B, Hauptmann M, Beijnen JH, Balm AJM, de Boer JP, Burgers JA, Marchetti S, Schellens JHM, Zuur CL. Transtympanic Sodium Thiosulfate for Prevention of Cisplatin-Induced Ototoxicity: A Randomized Clinical Trial. Otol Neurotol 2021; 42:678-685. [PMID: 33710154 DOI: 10.1097/mao.0000000000003069] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine safety, feasibility, and preliminary activity of transtympanic injection of sodium thiosulfate (STS) against cisplatin-induced hearing loss (CIHL).DESIGN Randomized controlled trial.SETTING Tertiary cancer hospital.PATIENTS Adults to be treated with high-dose cisplatin (≥ 75 mg/m2).INTERVENTION Selected by randomization, 0.1 M STS gel on one side and placebo gel on the other side was transtympanically applied to the middle ear 3 hours before cisplatin administration. After amendment, the placebo ear was left untreated. MAIN OUTCOME MEASURE Primary outcome was safety and feasibility. Secondary outcomes included pharmacokinetic analysis of systemic cisplatin and preliminary activity of STS. Clinically relevant CIHL was defined as a ≥ 10 dB threshold shift at pure-tone average 8-10-12.5 kHz (PTA8-12.5). Response to STS was defined as a threshold shift at PTA8-12.5 in the STS-treated ear of ≥ 10 dB smaller than the untreated ear. RESULTS Twelve patients were treated. Average CIHL at PTA8-12.5 was 12.7 dB in untreated ears and 8.8 dB SPL in STS-treated ears (p = 0.403). Four patients did not develop CIHL. Four out of eight patients with CIHL responded to STS: CIHL at PTA8-12.5 in STS-treated ears was 18.4 dB less compared to untreated ears (p = 0.068). Grade 1 adverse events were reported. Pharmacokinetic results were available for 11 patients. CONCLUSION Transtympanic application of STS was safe and feasible. Based on our pharmacokinetic analysis, we postulate that transtympanic STS does not interfere with the systemically available cisplatin. Our results provide a preliminary proof of concept for transtympanic application of STS in preventing CIHL and warrants further evaluation on a larger scale.
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Affiliation(s)
- Charlotte W Duinkerken
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Amsterdam
- Department of Otolaryngology, Leiden University Medical Centre, Leiden
| | - Vincent A de Weger
- Division of Clinical Pharmacology
- Division of Pharmacology, the Netherlands Cancer Institute, Amsterdam
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar
| | | | - Lisette van der Molen
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Amsterdam
| | - Dick Pluim
- Division of Pharmacology, the Netherlands Cancer Institute, Amsterdam
| | | | | | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Jos H Beijnen
- Division of Clinical Pharmacology
- Department of Pharmacy and Pharmacology
| | - Alfons J M Balm
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Amsterdam
- Department of Maxillofacial Surgery, Amsterdam University Medical Centre
| | | | - Jacobus A Burgers
- Department of Thoracic Oncology, the Netherlands Cancer Institute, Amsterdam
| | | | - Jan H M Schellens
- Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht
| | - Charlotte L Zuur
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Amsterdam
- Department of Maxillofacial Surgery, Amsterdam University Medical Centre
- Cell Biology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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14
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Gharzai LA, Burger N, Li P, Jaworski EM, Henderson C, Spector M, Rosko A, Chen MM, Prince ME, Bradford CR, Malloy KM, Stucken CL, Swiecicki P, Worden F, Schipper MJ, Schonewolf CA, Shah J, Jagsi R, Chinn S, Shuman A, Casper K, Mierzwa ML. Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV-Related Oropharyngeal Cancer. Oncologist 2021; 26:676-684. [PMID: 33823077 DOI: 10.1002/onco.13784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Optimal surveillance paradigms for survivors of early stage human papillomavirus (HPV)-related oropharyngeal cancer are not well defined. This study aimed to characterize patient interest in and factors associated with an altered surveillance paradigm. MATERIALS AND METHODS We surveyed patients with Stage I or II HPV-related oropharyngeal cancer treated at a tertiary care institution from 2016 to 2019. Primary outcomes were descriptive assessment of patient knowledge, interest in altered surveillance, burdens of in-person appointments, and priorities for surveillance visits. Ordinal regression was used to identify correlates of interest in altered surveillance. RESULTS Sixty-seven patients completed surveys from February to April 2020 at a median of 21 months since completing definitive treatment. A majority (61%) of patients were interested in a surveillance approach that decreased in-person clinic visits. Patients who self-identified as medical maximizers, had higher worry of cancer recurrence, or were in long-term relationships were less likely to be interested. Patients reported significant burdens associated with surveillance visits, including driving distance, time off work, and nonmedical costs. Patients were most concerned with discussing cancer recurrence (76%), physical quality of life (70%), mortality (61%), and mental quality of life (52%) with their providers at follow-up visits. CONCLUSION Patients with early stage HPV-related oropharyngeal cancers are interested in altered surveillance approaches, experience significant burdens related to surveillance visits, and have concerns that are not well addressed with current surveillance approaches, including physical and mental quality of life. Optimized surveillance approaches should incorporate patient priorities and minimize associated burdens. IMPLICATIONS FOR PRACTICE The number of patients with HPV-related oropharyngeal cancers is increasing, and numerous clinical trials are investigating novel approaches to treating these good-prognosis patients. There has been limited work assessing optimal surveillance paradigms in these patients. Patients experience significant appointment-related burdens and have concerns such as physical and mental quality of life. Additionally, patients with early stage HPV-related oropharyngeal cancers express interest in altered surveillance approaches that decrease in-person clinic visits. Optimization of surveillance paradigms to promote broader survivorship care in clinical practice is needed.
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas Burger
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pin Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth M Jaworski
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin Henderson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Spector
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andy Rosko
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle M Chen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Swiecicki
- Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis Worden
- Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin A Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Steve Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Shuman
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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15
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Rosenberg AJ, Vokes EE. Optimizing Treatment De-Escalation in Head and Neck Cancer: Current and Future Perspectives. Oncologist 2021; 26:40-48. [PMID: 32864799 PMCID: PMC7794179 DOI: 10.1634/theoncologist.2020-0303] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/06/2020] [Indexed: 01/21/2023] Open
Abstract
Treatment of locoregionally advanced head and neck squamous cell carcinoma involves a multidisciplinary approach that combines surgery, radiotherapy, and systemic therapy. These curative strategies are associated with significant acute and long-term toxicities. With the emergence of human papillomavirus (HPV) as an etiologic factor associated primarily with oropharyngeal squamous cell carcinoma, higher cure rates juxtaposed with substantial treatment-related morbidity and mortality has led to interest in de-escalated therapeutic strategies, with the goal of optimizing oncologic outcomes while reducing treatment-related toxicity. Currently explored strategies include replacing, reducing, or omitting cytotoxic chemotherapy; reducing dose or volume of radiotherapy; and incorporation of less-invasive surgical approaches. Potential biomarkers to select patients for treatment de-escalation include clinical risk stratification, adjuvant de-escalation based on pathologic features, response to induction therapy, and molecular markers. The optimal patient selection and de-escalation strategy is critically important in the evolving treatment of locoregional head and neck cancer. Recently, two large phase III trials, RTOG 1016 and De-ESCALaTE, failed to de-escalate treatment in HPV-associated head and neck cancer by demonstrating inferior outcomes by replacing cisplatin with cetuximab in combination with radiation. This serves as a cautionary tale in the future design of de-escalation trials in this patient population, which will need to leverage toxicity and efficacy endpoints. Our review summarizes completed and ongoing de-escalation trials in head and neck cancer, with particular emphasis on biomarkers for patient selection and clinical trial design. IMPLICATIONS FOR PRACTICE: The toxicity associated with standard multimodality treatment for head and neck cancer underscores the need to seek less-intensive therapies with a reduced long-term symptom burden through de-escalated treatment paradigms that minimize toxicity while maintaining oncologic control in appropriately selected patients. Controversy regarding the optimal de-escalation strategy and criteria for patient selection for de-escalated therapy has led to multiple parallel strategies undergoing clinical investigation. Well-designed trials that optimize multimodal strategies are needed. Given the absence of positive randomized trials testing de-escalated therapy to date, practicing oncologists should exercise caution and administer established standard-of-care therapy outside the context of a clinical trial.
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Affiliation(s)
- Ari J. Rosenberg
- Section of Hematology‐Oncology, The University of Chicago Medical CenterChicagoIllinoisUSA
| | - Everett E. Vokes
- Section of Hematology‐Oncology, The University of Chicago Medical CenterChicagoIllinoisUSA
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16
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Azzam P, Mroueh M, Francis M, Daher AA, Zeidan YH. Radiation-induced neuropathies in head and neck cancer: prevention and treatment modalities. Ecancermedicalscience 2020; 14:1133. [PMID: 33281925 PMCID: PMC7685771 DOI: 10.3332/ecancer.2020.1133] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Indexed: 12/24/2022] Open
Abstract
Head and neck cancer (HNC) is the sixth most common human malignancy with a global incidence of 650,000 cases per year. Radiotherapy (RT) is commonly used as an effective therapy to treat tumours as a definitive or adjuvant treatment. Despite the substantial advances in RT contouring and dosage delivery, patients suffer from various radiation-induced complications, among which are toxicities to the nervous tissues in the head and neck area. Radiation-mediated neuropathies manifest as a result of increased oxidative stress-mediated apoptosis, neuroinflammation and altered cellular function in the nervous tissues. Eventually, molecular damage results in the formation of fibrotic tissues leading to susceptible loss of function of numerous neuronal substructures. Neuropathic sequelae following irradiation in the head and neck area include sensorineural hearing loss, alterations in taste and smell functions along with brachial plexopathy, and cranial nerves palsies. Numerous management options are available to relieve radiation-associated neurotoxicities notwithstanding treatment alternatives that remain restricted with limited benefits. In the scope of this review, we discuss the use of variable management and therapeutic modalities to palliate common radiation-induced neuropathies in head and neck cancers.
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Affiliation(s)
- Patrick Azzam
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Manal Mroueh
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Marina Francis
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Alaa Abou Daher
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Youssef H Zeidan
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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17
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Mukherjea D, Dhukhwa A, Sapra A, Bhandari P, Woolford K, Franke J, Ramkumar V, Rybak L. Strategies to reduce the risk of platinum containing antineoplastic drug-induced ototoxicity. Expert Opin Drug Metab Toxicol 2020; 16:965-982. [PMID: 32757852 DOI: 10.1080/17425255.2020.1806235] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cisplatin is a highly effective chemotherapeutic agent against a variety of solid tumors in adults and in children. Unfortunately, a large percentage of patients suffer permanent sensorineural hearing loss. Up to 60% of children and at least 50% of adults suffer this complication that seriously compromises their quality of life. Hearing loss is due to damage to the sensory cells in the inner ear. The mechanisms of cochlear damage are still being investigated. However, it appears that inner ear damage is triggered by reactive oxygen species (ROS) formation and inflammation 34. AREAS COVERED We discuss a number of potential therapeutic targets that can be addressed to provide hearing protection. These strategies include enhancing the endogenous antioxidant pathways, heat shock proteins, G protein coupled receptors and counteracting ROS and reactive nitrogen species, and blocking pathways that produce inflammation, including TRPV1 and STAT1 36. EXPERT OPINION Numerous potential protective agents show promise in animal models by systemic or local administration. However, clinical trials have not shown much efficacy to date with the exception of sodium thiosulfate. There is an urgent need to discover safe and effective protective agents that do not interfere with the efficacy of cisplatin against tumors yet preserve hearing 151.
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Affiliation(s)
| | - Asmita Dhukhwa
- Springfield Combined Laboratory Facility, Novear Therapeutics LLC ., Springfield, IL, USA
| | - Amit Sapra
- Department of Internal Medicine, SIU School of Medicine , Springfield, IL, USA
| | - Priyanka Bhandari
- Department of Internal Medicine, SIU School of Medicine , Springfield, IL, USA
| | - Katlyn Woolford
- Department of Otolaryngology, SIU School of Medicine , Springfield, IL, USA
| | - Jacob Franke
- Department of Otolaryngology, SIU School of Medicine , Springfield, IL, USA
| | - Vickram Ramkumar
- Department of Pharmacology, SIU School of Medicine , Springfield, IL, USA
| | - Leonard Rybak
- Department of Otolaryngology, SIU School of Medicine , Springfield, IL, USA
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Driessen CM, Ham JC, Te Loo M, van Meerten E, van Lamoen M, Hakobjan MH, Takes RP, van der Graaf WT, Kaanders JH, Coenen MJH, van Herpen CM. Genetic Variants as Predictive Markers for Ototoxicity and Nephrotoxicity in Patients with Locally Advanced Head and Neck Cancer Treated with Cisplatin-Containing Chemoradiotherapy (The PRONE Study). Cancers (Basel) 2019; 11:cancers11040551. [PMID: 30999660 PMCID: PMC6520709 DOI: 10.3390/cancers11040551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/20/2019] [Accepted: 04/15/2019] [Indexed: 01/11/2023] Open
Abstract
Ototoxicity and nephrotoxicity are potentially irreversible side effects of chemoradiotherapy with cisplatin in locally advanced head and neck cancer (LAHNC) patients. Several predictive genetic variants have been described, but as yet none in LAHNC patients. The aim of this study is to investigate genetic variants as predictors for ototoxicity and nephrotoxicity in LAHNC patients treated with cisplatin-containing chemoradiotherapy. Our prospective cohort of 92 patients was genotyped for 10 genetic variants and evaluated for their association with cisplatin-induced ototoxicity (ACYP2, COMT, TPMT and WFS1) and nephrotoxicity (OCT2, MATE and XPD). Ototoxicity was determined by patient-reported complaints as well as tone audiometrical assessments. Nephrotoxicity was defined as a decrease of ≥25% in creatinine clearance during treatment compared to baseline. A significant association was observed between carriership of the A allele for rs1872328 in the ACYP2 gene and cisplatin-induced clinically determined ototoxicity (p = 0.019), and not for ototoxicity measured by tone audiometrical assessments (p = 0.449). Carriership of a T allele for rs316019 in the OCT2 gene was significantly associated with nephrotoxicity at any time during chemoradiotherapy (p = 0.022), but not with nephrotoxicity at the end of the chemoradiotherapy. In conclusion, we showed prospectively that in LAHNC patients genetic variants in ACYP2 are significantly associated with clinically determined ototoxicity. Validation studies are necessary to prove the added value for individualized treatments plans in these patients.
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Affiliation(s)
- Chantal M Driessen
- Department of Medical Oncology, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
| | - Janneke C Ham
- Department of Medical Oncology, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
| | - Maroeska Te Loo
- Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
| | - Esther van Meerten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Postbox 2040, 3000 CA Rotterdam, The Netherlands.
| | - Maurits van Lamoen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
| | - Marina H Hakobjan
- Department of Human Genetics, Radboud Institute of Health Sciences, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
| | - Winette T van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
| | - Johannes H Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud Institute of Health Sciences, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
| | - Carla M van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
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19
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Rolland V, Meyer F, Guitton MJ, Bussières R, Philippon D, Bairati I, Leclerc M, Côté M. A randomized controlled trial to test the efficacy of trans-tympanic injections of a sodium thiosulfate gel to prevent cisplatin-induced ototoxicity in patients with head and neck cancer. J Otolaryngol Head Neck Surg 2019; 48:4. [PMID: 30651130 PMCID: PMC6335693 DOI: 10.1186/s40463-019-0327-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background Cisplatin-induced hearing loss is frequent and severe. Antioxidants such as sodium thiosulfate (STS) can neutralize the effects of cisplatin. The objective of the trial was to test the efficacy of trans-tympanic injections of a STS gel to prevent cisplatin-induced ototoxicity. Methods Eligible participants were newly diagnosed patients with stage III or IV squamous cell carcinoma of the mouth, oropharynx, hypopharynx, or larynx and scheduled to be treated by concurrent chemoradiation (CCR). Patients with asymmetric hearing were not eligible. The planed treatment included cisplatin 100 mg/m2 at days 1, 22 and 43. A baseline pre-treatment complete audiometric evaluation (pure tone at frequencies ranging from 0.5 to 14 kHz, bone conduction at 0.5–4 kHz and DPOAEs) was performed. Adverse effects were noted according to CTCAE. On the day before the beginning of CCR, eligible and consenting patients were randomized to receive a trans-tympanic injection of the gel either in the left ear or in the right ear. A final post-treatment complete audiometric evaluation was scheduled to be performed 1 month after the end of CCR by audiologists kept blind to the ear assignment. For the main outcome, the permanent threshold shift (PTS) in decibel (dB) was calculated as the difference between the final and baseline measures at all pure tone frequencies at 0.5–14 kHz for each patient and for each ear. The main outcome was assessed blindly in a mixed linear model with the PTS as the dependent variable and intervention, frequency, their interaction and radiation dose to the cochlea as independent variables. Results Between January 2015 and April 2016, 13 patients were randomized. The trial was stopped in June 2016 for poor accrual. The average loss of hearing over all frequencies was 1.3 dB less for treated ears compared to control ears. Although not statistically (p = 0.61) nor clinically significant, the difference was in favor of the treated ears for all frequencies between 3 and 10 kHz. Conclusions Our trial suggests that STS deposited on the round window was safe for the middle and inner ears. More work is needed to improve the efficacy of trans-tympanic injections of cisplatin antidotes. Trial registration ClinicalTrials.gov, NTC02281006, Registered 3 November 2014.
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Affiliation(s)
- Viannique Rolland
- Department of Ophthalmology and Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry, Bureau 4889, 1050, avenue de la Médecine, Québec City, QC, G1V A06, Canada.,Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec City, QC, Canada
| | - François Meyer
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Laval University Cancer Research Center, Quebec City, Canada
| | - Matthieu J Guitton
- Department of Ophthalmology and Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry, Bureau 4889, 1050, avenue de la Médecine, Québec City, QC, G1V A06, Canada.,CERVO Brain Research Center, Quebec City, QC, Canada
| | - Richard Bussières
- Department of Ophthalmology and Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry, Bureau 4889, 1050, avenue de la Médecine, Québec City, QC, G1V A06, Canada.,Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec City, QC, Canada
| | - Daniel Philippon
- Department of Ophthalmology and Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry, Bureau 4889, 1050, avenue de la Médecine, Québec City, QC, G1V A06, Canada.,Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec City, QC, Canada
| | - Isabelle Bairati
- Laval University Cancer Research Center, Quebec City, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Mathieu Leclerc
- Department of Ophthalmology and Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry, Bureau 4889, 1050, avenue de la Médecine, Québec City, QC, G1V A06, Canada.,Department of Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Mathieu Côté
- Department of Ophthalmology and Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry, Bureau 4889, 1050, avenue de la Médecine, Québec City, QC, G1V A06, Canada. .,Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec City, QC, Canada.
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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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Driessen CML, Leijendeckers J, Snik A, van der Graaf WTA, de Boer JP, Gelderblom H, Kaanders JHAM, Takes R, van Herpen CML. Ototoxicity in locally advanced head and neck cancer patients treated with induction chemotherapy followed by intermediate or high-dose cisplatin-based chemoradiotherapy. Head Neck 2018; 41:488-494. [PMID: 30536479 DOI: 10.1002/hed.25434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/03/2018] [Accepted: 09/21/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study evaluated ototoxicity in locally advanced head and neck cancer patients treated in the CONDOR study with docetaxel/cisplatin/5-fluorouracil (TPF) followed by conventional radiotherapy with concomitant cisplatin 100 mg/m2 on days 1, 22, and 43 (cis100+RT) versus accelerated radiotherapy with concomitant cisplatin weekly 40 mg/m2 (cis40+ART). METHODS Sixty-two patients were treated in this study. Audiometry was performed at baseline, during TPF, before start of chemoradiotherapy, and 1, 4, 8, and 12 months after treatment. RESULTS A complete dataset of audiometric data was available of 12 patients treated with high-dose cisplatin and of 11 patients treated with intermediate-dose cisplatin. Patients in the high-dose group showed significant more hearing loss than in the intermediate group at 4 kHz ([z = 1.98; P = .04] and 8 kHz [z = 2.07; P < .03]). Interindividual variation was high in both groups. CONCLUSION After induction TPF, more ototoxicity was observed in chemoradiotherapy with cis100+RT than after chemoradiotherapy with cis40+ART.
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Affiliation(s)
- Chantal M L Driessen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joop Leijendeckers
- Department of Ear Nose and Throat/Audiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad Snik
- Department of Ear Nose and Throat/Audiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.,The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jan Paiul de Boer
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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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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Schroeder RJ, Audlin J, Luo J, Nicholas BD. Pharmacokinetics of sodium thiosulfate in Guinea pig perilymph following middle ear application. J Otol 2018; 13:54-58. [PMID: 30559765 PMCID: PMC6291635 DOI: 10.1016/j.joto.2017.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022] Open
Abstract
Hypothesis To determine the pharmacokinetics of sodium thiosulfate in the inner ear perilymph following middle ear application in Guinea pigs. Background Cisplatin chemotherapy is often associated with a dose-dependent high frequency sensorineural hearing loss. Sodium thiosulfate has been shown to reduce cisplatin-induced ototoxicity when given intravenously, but this may limit the tumoricidal effects of the chemotherapy. Recent animal studies looking at middle ear application of sodium thiosulfate have shown prevention of outer hair cell and hearing loss, but the perilymph pharmacokinetics have not yet been established. Methods Twenty Guinea pig ears were split into two groups and administered sodium thiosulfate to the middle ear at either a concentration of 250 mg/mL or 50 mg/mL for 30 min. Perilymph samples were then obtained serially through the round window over 6 h. Sodium thiosulfate concentrations were obtained using high-pressure liquid chromatography. Results The 250 mg/mL group had a maximum perilymph concentration of 7.27 mg/mL (±0.83) that decreased to 0.94 mg/mL (±0.03) over 6 h. The 50 mg/mL group had an initial concentration of 1.63 mg/mL (±0.17) and was undetectable after 1 h. The half-life of sodium thiosulfate within perilymph was 0.74 h. Conclusions and Relevance: The results of this study show that sodium thiosulfate is capable of diffusing through round window and into the inner ear perilymph. Peak levels decline over several hours after exposure. This has a potential application as a localized therapy in the prevention of cisplatin induced ototoxicity.
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Hazlitt RA, Min J, Zuo J. Progress in the Development of Preventative Drugs for Cisplatin-Induced Hearing Loss. J Med Chem 2018; 61:5512-5524. [PMID: 29361217 PMCID: PMC6043375 DOI: 10.1021/acs.jmedchem.7b01653] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
![]()
Cisplatin
is a highly effective treatment for malignant cancers
and has become a cornerstone in chemotherapeutic regimens. Unfortunately,
its use in the clinic is often coupled with a high incidence of severe
hearing loss. Over the past few decades, enormous effort has been
put forth to find protective agents that selectively protect against
the ototoxic side effects of cisplatin and do not interfere with its
antitumoral activity. Many therapies have been successful in preclinical
work, but only a few have shown any protection in the clinic, and
none have been approved by the FDA. This review summarizes the clinical
and preclinical studies of the most effective small-molecule candidates
currently in clinical trials, while also detailing their molecular
mechanisms of action, to gain insight for future drug development
in the field.
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Schmitt NC, Page BR. Chemoradiation-induced hearing loss remains a major concern for head and neck cancer patients. Int J Audiol 2017; 57:S49-S54. [PMID: 28728452 DOI: 10.1080/14992027.2017.1353710] [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] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Review of the literature regarding hearing loss in patients with head and neck cancer treated with chemoradiation. DESIGN Studies in the literature are reviewed that pertain to hearing loss sustained in head and neck cancer patients receiving cisplatin-based chemoradiation. Personal observations noted while treating these patients are also detailed. STUDY SAMPLE PubMed was searched for pertinent articles regarding hearing loss in head and neck cancer patients receiving cisplatin chemotherapy and/or radiation. RESULTS Studies on the incidence and severity of hearing loss in head and neck cancer patients are limited, but those studies suggest that the risk of hearing loss is greater with higher-dose regimens. CONCLUSIONS Newer cisplatin chemotherapy regimens using lower, weekly doses may be associated with a lower incidence and severity of hearing loss; however, large prospective studies are needed. Such information will be paramount to effective pre-treatment counselling of head and neck cancer patients.
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Affiliation(s)
- Nicole C Schmitt
- a Office of the Clinical Director , National Institute on Deafness and Other Communication Disorders, National Institutes of Health , Bethesda , MD , USA.,b Department of Otolaryngology - Head and Neck Surgery , Johns Hopkins University , Baltimore , MD , USA , and
| | - Brandi R Page
- c Department of Radiation Oncology and Molecular Sciences , Johns Hopkins University , Baltimore , MD , USA
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Abstract
OBJECTIVE To critically review and evaluate the proposed mechanisms and documented results of the therapeutics currently in active clinical drug trials for the treatment of sensorineural hearing loss. DATA SOURCES US National Institutes of Health (NIH) Clinical Trials registry, MEDLINE/PubMed. STUDY SELECTION & DATA EXTRACTION A review of the NIH Clinical Trials registry identified candidate hearing loss therapies, and supporting publications were acquired from MEDLINE/PubMed. Proof-of-concept, therapeutic mechanisms, and clinical outcomes were critically appraised. DATA SYNTHESIS Twenty-two active clinical drug trials registered in the United States were identified, and six potentially therapeutic molecules were reviewed. Of the six molecules reviewed, four comprised mechanisms pertaining to mitigating oxidative stress pathways that presumably lead to inner ear cell death. One remaining therapy sought to manipulate the cell death cascade, and the last remaining therapy was a novel cell replacement therapy approach to introduce a transcription factor that promotes hair cell regeneration. CONCLUSION A common theme in recent clinical trials registered in the United States appears to be the targeting of cell death pathways and influence of oxidant stressors on cochlear sensory neuroepithelium. In addition, a virus-delivered cell replacement therapy would be the first of its kind should it prove safe and efficacious. Significant challenges for bringing these bench-to-bedside therapies to market remain. It is never assured that results in non-human animal models translate to effective therapies in the setting of human biology. Moreover, as additional processes are described in association with hearing loss, such as an immune response and loss of synaptic contacts, additional pathways for targeting become available.
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Affiliation(s)
- Matthew G. Crowson
- Division of Head & Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC USA
| | - Ronna Hertzano
- Department of Otorhinolaryngology Head & Neck Surgery, Anatomy and Neurobiology and Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD USA
| | - Debara Tucci
- Division of Head & Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, NC USA
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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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Platinum-induced ototoxicity: a review of prevailing ototoxicity criteria. Eur Arch Otorhinolaryngol 2016; 274:1187-1196. [DOI: 10.1007/s00405-016-4117-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/24/2016] [Indexed: 02/07/2023]
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Ishikawa E, Sugimoto H, Hatano M, Nakanishi Y, Tsuji A, Endo K, Kondo S, Wakisaka N, Murono S, Ito M, Yoshizaki T. Protective effects of sodium thiosulfate for cisplatin-mediated ototoxicity in patients with head and neck cancer. Acta Otolaryngol 2015; 135:919-24. [PMID: 25861690 DOI: 10.3109/00016489.2015.1035797] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Intra-arterial high-dose cisplatin chemoradiation (CRT-IA) with sodium thiosulfate (STS) causes relatively less severe cisplatin ototoxicity than intravenous cisplatin chemoradiation without STS (CRT-IV). The results of this study also suggest that early detection of ototoxicity is possible by testing the hearing loss at ultra-high frequencies. OBJECTIVES To investigate protective effects of STS against cisplatin ototoxicity. METHODS Between 2011 and 2013, 18 patients with head and neck carcinomas were treated with intra-arterial infusions of high-dose cisplatin (range 100-180 mg/body, mean 111 mg/body; range 2-5 courses, mean 3.6 courses) and systemic administration of cisplatin (range 66-185 mg/body, mean 130 mg/body; range 1-3 courses, mean 2.6 courses) and concurrent radiation therapy (range 60-70 Gy, mean 69 Gy). Cisplatin was neutralized by STS in CRT-IA but not in CRT-IV. RESULTS Intra-arterial infusion in the high-dose cisplatin group caused significant hearing loss at ultra-high frequencies of 10 and 12 kHz (p = 0.028, 0.039, respectively), whereas the group receiving systemic administration of cisplatin had significant hearing loss at high frequencies of 8 and 10 kHz (p = 0.016, 0.027, respectively).
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Affiliation(s)
- Eriko Ishikawa
- Otolaryngology-Head and Neck Surgery, Toyama Prefectural Hospital , Toyama
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Heukelom J, Lopez-Yurda M, Balm AJM, Wijers OB, Buter J, Gregor T, Wiggenraad R, de Boer JP, Tan IB, Verheij M, Sonke JJ, Rasch CR. Late follow-up of the randomized radiation and concomitant high-dose intra-arterial or intravenous cisplatin (RADPLAT) trial for advanced head and neck cancer. Head Neck 2015; 38 Suppl 1:E488-93. [DOI: 10.1002/hed.24023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jolien Heukelom
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Marta Lopez-Yurda
- Department of Statics; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Alfons J. M. Balm
- Department of Head and Neck Oncology and Surgery; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Oda B. Wijers
- Department of Radiation Oncology; Radiotherapeutisch Instituut Friesland; Leeuwarden The Netherlands
| | - Jan Buter
- Department of Medical Oncology; VU University Medical Center; Amsterdam The Netherlands
| | - Theo Gregor
- Department of Radiation Oncology; Waikato Hospital; Hamilton New Zealand
| | - Ruud Wiggenraad
- Department of Radiation Oncology; Medisch Centrum Haaglanden; The Hague The Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - I. Bing Tan
- Department of Head and Neck Oncology and Surgery; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Coen R. Rasch
- Department of Radiation Oncology; Amsterdam Medical Center; Amsterdam The Netherlands
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Gao J, Qian TL, Tao CZ, Zhang YH, Zhou Y, Yang J, He J, Wang R, Zhou PJ. SmartArc-based volumetric modulated arc therapy can improve the middle ear, vestibule and cochlea sparing for locoregionally advanced nasopharyngeal carcinoma: a dosimetric comparison with step-and-shoot intensity-modulated radiotherapy. Br J Radiol 2015; 88:20150052. [PMID: 26111068 DOI: 10.1259/bjr.20150052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Radiation-induced sensorineural hearing loss is a common complication after radiotherapy in patients with nasopharyngeal carcinoma (NPC) that significantly affects their quality of life. The goal of this study was to compare SmartArc-based volumetric modulated arc therapy (VMAT-S) with step-and-shoot intensity-modulated radiation therapy (IMRT) for patients with locoregionally advanced NPC with regard to the sparing effect on middle ear, vestibule and cochlea. METHODS 20 patients with non-metastatic Stage III or IV NPC were selected to have planning with VMAT-S and IMRT [using Philips Pinnacle Planning System (Philips, Fitchburg, WI) for Varian accelerator] for dosimetric comparison. Mean middle ears, vestibule and cochlea doses for the two planning techniques were compared using a paired t-test. Target coverage and dose homogeneity were evaluated by calculating conformity index (CI) and homogeneity index (HI) values. RESULTS VMAT-S had significantly improved homogeneity and conformity compared with IMRT. Mean HI of planning target volume of gross tumour volume (PGTV) was better with VMAT-S (1.05 ± 0.02) than IMRT (1.09 ± 0.03) (p < 0.001). Mean CI of PGTV is also better with VMAT-S (0.59 ± 0.12) than IMRT (0.54 ± 0.12) (p < 0.001). Mean doses to the left cochleas were 43.8 ± 3.6 and 47.8 ± 4.0 (p < 0.001) for VMAT-S and IMRT plans, respectively. Mean doses to the right cochleas were 42.7 ± 4.7 and 47.6 ± 5.4 (p < 0.001) for VMAT-S and IMRT plans, respectively. VMAT-S also significantly reduced the mean doses to middle ears (p < 0.001 for both) and vestibule (p < 0.001 for both). CONCLUSION Our results indicate that VMAT-S provides better sparing of hearing apparatus in locoregionally advanced NPC. ADVANCES IN KNOWLEDGE VMAT-S can improve the middle ear, vestibule and cochlea sparing in patients with locoregionally advanced NPC.
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Affiliation(s)
- J Gao
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - T-L Qian
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - C-Z Tao
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Y-H Zhang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Y Zhou
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - J Yang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - J He
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - R Wang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - P-J Zhou
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
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Hearing Loss After Cisplatin: Oxidative Stress Pathways and Potential for Protection. FREE RADICALS IN ENT PATHOLOGY 2015. [DOI: 10.1007/978-3-319-13473-4_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Theunissen EAR, Zuur CL, Bosma SCJ, Lopez-Yurda M, Hauptmann M, van der Baan S, de Boer JP, van der Molen L, Rasch CRN, Dreschler WA, Balm AJM. Long-term hearing loss after chemoradiation in patients with head and neck cancer. Laryngoscope 2014; 124:2720-5. [PMID: 24964759 DOI: 10.1002/lary.24802] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/23/2014] [Accepted: 06/03/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to determine whether concomitant chemoradiation (CCRT)-induced hearing loss is progressive over time or not. STUDY DESIGN Long-term (LT) follow-up study. METHODS Between 1999 and 2004, 158 patients with head and neck cancer were treated with intravenous (IV) CCRT (n = 80) or intraarterial CCRT (n = 78). Audiometry was performed before, short-term (ST), and LT posttreatment. Differences in hearing were assessed with a multivariable linear regression analysis, incorporating the effect of aging. RESULTS Long-term audiometry (median 4.5 years) was available in 67 patients (42%). At ST follow-up, a deterioration of 21.6 decibel was seen compared to baseline at pure-tone averages (PTA) 8-10-12.5 kHz. At LT follow-up, this deterioration further increased with 5 decibel (P = 0.005). Only in CCRT-IV patients was a significant progressive treatment-induced hearing loss seen, at PTA 8-10-12.5 kHz (P = 0.005), PTA 1-2-4 kHz air conduction (P = 0.014), and PTA 0.5-1-2 kHz bone conduction (P = 0.045). CONCLUSION CCRT-induced hearing impairment was progressive over time, especially in higher frequencies and only in CCRT-IV patients, with a modest deterioration of 5 decibel 4.5 years post-treatment. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Eleonoor A R Theunissen
- Department of Head and Neck Oncology and Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Theunissen EA, Dreschler WA, Latenstein MN, Rasch CR, van der Baan S, de Boer JP, Balm AJ, Zuur CL. A New Grading System for Ototoxicity in Adults. Ann Otol Rhinol Laryngol 2014; 123:711-8. [DOI: 10.1177/0003489414534010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: This study aimed to propose an ototoxicity grading system sensitive to the effect of ototoxicity on specific daily life situations like speech intelligibility and the perception of ultra-high sounds and to test its feasibility compared to current criteria. Methods: Pure tone averages (PTAs) for speech perception (1-2-4 kHz) and ultra-high frequencies (8-10-12.5 kHz) were incorporated. Threshold shift and hearing level posttreatment were taken into account. Criteria were tested on head and neck cancer patients treated with (chemo-)radiotherapy ([C]RT) and compared with the Common Terminology Criteria for Adverse Events version 4 (CTCAEv4) and the American Speech-Language-Hearing Association criteria (ASHA). Results: Grades 1 and 2 were based on threshold shifts from baseline (in dB) and subjective complaints. Grades 3 and 4 were defined as treatment-induced hearing loss of ≥ 35 dB at PTA 1-2-4 kHz and ≥ 70 dB at PTA 1-2-4 kHz, respectively. In high-dose cisplatin CRT incidences by the new criteria, CTCAEv4 and ASHA were comparable (78%-88%). In RT and low-dose cisplatin CRT, incidences were 36% to 39% in the new criteria versus 22% to 53% in CTCAEv4 and ASHA. Conclusion: The new criteria show an increased sensitivity to ototoxicity compared to CTCAEv4 and ASHA and provide insight into the effect of hearing loss on certain daily life situations. The new grading system seems feasible for clinic and research purposes.
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Affiliation(s)
- Eleonoor A.R. Theunissen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wouter A. Dreschler
- Department of Audiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Merel N. Latenstein
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Coen R.N. Rasch
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sieberen van der Baan
- Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alfons J.M. Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte L. Zuur
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Theunissen EAR, Bosma SCJ, Zuur CL, Spijker R, van der Baan S, Dreschler WA, de Boer JP, Balm AJM, Rasch CRN. Sensorineural hearing loss in patients with head and neck cancer after chemoradiotherapy and radiotherapy: A systematic review of the literature. Head Neck 2014; 37:281-92. [DOI: 10.1002/hed.23551] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eleonoor A. R. Theunissen
- Department of Head and Neck Oncology and Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Sophie C. J. Bosma
- Department of Head and Neck Oncology and Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Charlotte L. Zuur
- Department of Head and Neck Oncology and Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
- Department of Maxillofacial Surgery; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - René Spijker
- Medical Library, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
- Dutch Cochrane Center; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Sieberen van der Baan
- Department of Otorhinolaryngology; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Wouter A. Dreschler
- Department of Otorhinolaryngology-Audiology; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology; The Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Alfons J. M. Balm
- Department of Head and Neck Oncology and Surgery; The Netherlands Cancer Institute; Amsterdam The Netherlands
- Department of Maxillofacial Surgery; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology; Academic Medical Center, University of Amsterdam; Amsterdam The Netherlands
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The role of thiamine pyrophosphate in prevention of cisplatin ototoxicity in an animal model. ScientificWorldJournal 2013; 2013:182694. [PMID: 24163613 PMCID: PMC3791633 DOI: 10.1155/2013/182694] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/11/2013] [Indexed: 12/20/2022] Open
Abstract
Objective. The aim of this study was to evaluate the effectiveness of thiamine pyrophosphate against cisplatin-induced ototoxicity in guinea pigs. Materials and Methods. Healthy guinea pigs (n = 18) were randomly divided into three groups. Group 1 (n = 6) received an intraperitoneal injection of saline solution and cisplatin for 7 days, group 2 (n = 6) received an intraperitoneal injection of thiamine pyrophosphate and cisplatin for 7 days, and group 3 (n = 6) received only intraperitoneal injection of saline for 7 days. The animals in all groups were sacrificed under anesthesia, and their cochleas were harvested for morphological and biochemical observations. Results. In group 1, receiving only cisplatin, cochlear glutathione concentrations, superoxide dismutase, and glutathione peroxidase activities significantly decreased (P < 0.05) and malondialdehyde concentrations significantly increased (P < 0.05) compared to the control group. In group 2, receiving thiamine pyrophosphate and cisplatin, the concentrations of enzymes were near those of the control group. Microscopic examination showed that outer hair cells, spiral ganglion cells, and stria vascularis were preserved in group 2. Conclusion. Systemic administration of thiamine pyrophosphate yielded statistically significant protection to the cochlea of guinea pigs from cisplatin toxicity. Further experimental animal studies are essential to determine the appropriate indications of thiamine pyrophosphate before clinical use.
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Shafik AG, Elkabarity RH, Thabet MT, Soliman NB, Kalleny NK. Effect of intratympanic dexamethasone administration on cisplatin-induced ototoxicity in adult guinea pigs. Auris Nasus Larynx 2013; 40:51-60. [DOI: 10.1016/j.anl.2012.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 05/15/2012] [Accepted: 05/23/2012] [Indexed: 12/13/2022]
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Brock PR, Knight KR, Freyer DR, Campbell KCM, Steyger PS, Blakley BW, Rassekh SR, Chang KW, Fligor BJ, Rajput K, Sullivan M, Neuwelt EA. Platinum-induced ototoxicity in children: a consensus review on mechanisms, predisposition, and protection, including a new International Society of Pediatric Oncology Boston ototoxicity scale. J Clin Oncol 2012; 30:2408-17. [PMID: 22547603 DOI: 10.1200/jco.2011.39.1110] [Citation(s) in RCA: 251] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The platinum chemotherapy agents cisplatin and carboplatin are widely used in the treatment of adult and pediatric cancers. Cisplatin causes hearing loss in at least 60% of pediatric patients. Reducing cisplatin and high-dose carboplatin ototoxicity without reducing efficacy is important. PATIENTS AND METHODS This review summarizes recommendations made at the 42nd Congress of the International Society of Pediatric Oncology (SIOP) in Boston, October 21-24, 2010, reflecting input from international basic scientists, pediatric oncologists, otolaryngologists, oncology nurses, audiologists, and neurosurgeons to develop and advance research and clinical trials for otoprotection. RESULTS Platinum initially impairs hearing in the high frequencies and progresses to lower frequencies with increasing cumulative dose. Genes involved in drug transport, metabolism, and DNA repair regulate platinum toxicities. Otoprotection can be achieved by acting on several these pathways and generally involves antioxidant thiol agents. Otoprotection is a strategy being explored to decrease hearing loss while maintaining dose intensity or allowing dose escalation, but it has the potential to interfere with tumoricidal effects. Route of administration and optimal timing relative to platinum therapy are critical issues. In addition, international standards for grading and comparing ototoxicity are essential to the success of prospective pediatric trials aimed at reducing platinum-induced hearing loss. CONCLUSION Collaborative prospective basic and clinical trial research is needed to reduce the incidence of irreversible platinum-induced hearing loss, and optimize cancer control. Wide use of the new internationally agreed-on SIOP Boston ototoxicity scale in current and future otoprotection trials should help facilitate this goal.
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Affiliation(s)
- Penelope R Brock
- Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom
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Abstract
OBJECTIVES/HYPOTHESIS To design a grading scale and audiologic protocols to better reflect clinical impact than the currently widely used classifications. STUDY DESIGN Retrospective. METHODS Audiologic studies from 130 patients receiving cisplatin chemotherapy were analyzed. Pure-tone audiograms were evaluated using the newly proposed grading criteria, Brock criteria, and Common Terminology Criteria for Adverse Events (CTCAE). The resulting grades were then compared to recommended audiologic interventions. Auditory brainstem response (ABR) data and data on incidences of conductive hearing loss from other multi-institutional studies that the author participated in were compared to data from this cohort. RESULTS Although the newly proposed, Brock, and CTCAE ototoxicity grades were significantly related to audiologist recommendations for assistive devices (P < .0001), the newly proposed criteria were more specific and allowed better delineation of different patients into distinct subgroups requiring either FM system (grade 2a) or hearing aid (grade 2b or higher). Multi-institutional data review indicated significant problems with ABR evaluations and separating out conductive hearing losses from ototoxicity. CONCLUSIONS The newly proposed grading system needs to be paired with specific recommendations regarding audiologic monitoring protocols as well as active participation by the audiologists implementing the protocol to provide clinically accurate assessment and grading of ototoxicity.
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Affiliation(s)
- Kay W Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California 94305, USA.
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Murphy D, Daniel SJ. Intratympanic Dexamethasone to Prevent Cisplatin Ototoxicity. Otolaryngol Head Neck Surg 2011; 145:452-7. [DOI: 10.1177/0194599811406673] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective. To determine whether intratympanic administration of dexamethasone reduces ototoxicity from systemic cisplatin. Study Design. Prospective animal study. Setting. Cisplatin chemotherapy induces ototoxicity manifesting as irreversible, sensorineural hearing loss. This is due to damage to the inner ear structures by free radicals. Steroidal anti-inflammatories have been shown to reduce the formation of free radicals and protect hearing in animal models. Subjects and Methods. Pure tone auditory brainstem responses were obtained in 58 female albino guinea pigs before and 3 days after intraperitoneal (IP) cisplatin chemotherapy. Auditory brainstem responses were also taken up to 1 month after a low dose of cisplatin. Part I consisted of a dosing study to determine the optimal ototoxic dose of cisplatin. In part II, auditory brainstem response thresholds were compared after bilateral intratympanic dexamethasone doses to act as controls. For part III, the otoprotection of dexamethasone against cisplatin was tested in separate bilateral and unilateral studies. Results. IP injection of 12 mg/kg of cisplatin induced significant hearing loss (57.2 ± 4.4 dB, P < .01) with 0% mortality. Ears treated with intratympanic dexamethasone alone showed no significant threshold changes. Ears that received IP cisplatin and intratympanic dexamethasone showed reduced threshold shifts at 8 kHz when the greatest concentration of dexamethasone was administered. Conclusion. Modest intratympanic dexamethasone otoprotection of the guinea pig ear was greatest at the highest concentration tested and occurred in a frequency-dependent manner. Intratympanic dexamethasone presents as a safe, simple, and effective treatment modality to minimize cisplatin ototoxicity without interfering with the chemotherapeutic effects of cisplatin.
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Affiliation(s)
- Denise Murphy
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada
| | - Sam J. Daniel
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada
- Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
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Li Y, Ding D, Jiang H, Fu Y, Salvi R. Co-administration of cisplatin and furosemide causes rapid and massive loss of cochlear hair cells in mice. Neurotox Res 2011; 20:307-19. [PMID: 21455790 DOI: 10.1007/s12640-011-9244-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/10/2011] [Accepted: 03/21/2011] [Indexed: 12/24/2022]
Abstract
The expanding arsenal of transgenic mice has created a powerful tool for investigating the biological mechanisms involved in ototoxicity. However, cisplatin ototoxicity is difficult to investigate in mice because of their small size and vulnerability to death by nephrotoxicity. To overcome this problem, we developed a strategy for promoting cisplatin-induced ototoxicity by coadministration of furosemide a loop diuretic. A dose-response study identified 200 mg/kg of furosemide as the optimal dose for disrupting the stria vascularis and opening the blood-ear barrier. Our analysis of stria pathology indicated that the optimal period for administering cisplatin was 1 h after furosemide treatment. Combined treatment with 0.5 mg/kg of cisplatin and 200 mg/kg furosemide resulted in only moderate loss of outer hair cells in the basal 20% of the cochlea, only mild threshold shifts and minimal loss of distortion product otoacoustic emission (DPOAE). In contrast, 1 mg/kg of cisplatin plus 200 mg/kg of furosemide resulted in a permanent 40-50 dB elevation of auditory brainstem response thresholds, almost complete elimination of DPOAE, and nearly total loss of outer hair cells. The widespread outer hair cell lesions that develop in mice treated with cisplatin plus furosemide could serve as extremely useful murine model for investigating techniques for regenerating outer hair cells, studying the mechanisms of cisplatin and furosemide ototoxicity and assessing the perceptual and electrophysiological consequences of outer hair cell loss on central auditory plasticity.
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Affiliation(s)
- Yongqi Li
- Center for Hearing and Deafness, University at Buffalo, 137 Cary Hall, Buffalo, NY 14214, USA
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Mauricio RV, Green H, Hayes-Jordan A. Care of Pediatric Oncology Patients After Continuous Hyperthermic Peritoneal Perfusion. Crit Care Nurse 2010; 30:58-70; quiz 71. [DOI: 10.4037/ccn2010252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Riza V. Mauricio
- Riza V. Mauricio is a nurse practitioner in the pediatric intensive care unit at the Children’s Cancer Hospital of the University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Holly Green
- Holly Green is a surgical physician assistant at the Children’s Cancer Hospital of the University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Andrea Hayes-Jordan
- Andrea Hayes-Jordan is a pediatric surgeon and director of pediatric surgical oncology at the Children’s Cancer Hospital of the University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Chang KW, Chinosornvatana N. Practical grading system for evaluating cisplatin ototoxicity in children. J Clin Oncol 2010; 28:1788-95. [PMID: 20194861 DOI: 10.1200/jco.2009.24.4228] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We present a new ototoxicity grading system that has clearly defined and frequency-specific audiometric criteria. The purpose of this study was to validate this grading system by assessing its correspondence to audiology treatment recommendations and comparing it with the currently utilized Common Terminology Criteria for Adverse Events (CTCAE). PATIENTS AND METHODS A retrospective chart review was conducted using audiologic, demographic, and clinical data from 134 children receiving 149 courses of chemotherapy consisting of cisplatin and/or carboplatin. Pure-tone audiograms were evaluated using both our proposed grading criteria and the CTCAE criteria. The resulting grades were then compared with charted audiologic interventions and a number of clinical parameters to assess the clinical validity of the grading scale. RESULTS Chang grade 2a or higher predicted audiologic intervention. Although both the Chang and CTCAE ototoxicity grades were significantly related to audiologist recommendations for assistive devices such as hearing aids and/or frequency modulated systems (P < .0001), the Chang scale was more specific, with the CTCAE scale diverging from clinical recommendation at higher grades. As expected, patients receiving cisplatin had more severe hearing loss with concurrent carboplatin administration, radiation therapy exposure, younger age, smaller body-surface area, longer treatment exposure, and more severe disease. CONCLUSION This grading system provides robust and clinically useful criteria to represent clinical hearing loss induced by ototoxicity with regard to the impact on speech and language and the need for assistive hearing devices. It is both more specific and more sensitive than the traditional CTCAE criteria for identifying clinically significant ototoxicity.
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Affiliation(s)
- Kay W Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Risk Factors for Hearing Loss in Patients Treated With Intensity-Modulated Radiotherapy for Head-and-Neck Tumors. Int J Radiat Oncol Biol Phys 2009; 74:490-6. [DOI: 10.1016/j.ijrobp.2008.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 08/20/2008] [Accepted: 08/20/2008] [Indexed: 11/23/2022]
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Abstract
HYPOTHESIS Intratympanic (IT) application of dexamethasone will reduce ototoxicity associated with systemic cisplatin therapy. BACKGROUND Cisplatin is a common chemotherapeutic drug often dose-limited by ototoxicity attributed to the formation of reactive oxygen and nitrogen species damaging critical inner ear structures. Steroids have been shown to reduce formation of reactive oxygen species and thus may reduce ototoxicity. In the present pilot study, we test this hypothesis by IT administration of dexamethasone in a novel murine model of cisplatin ototoxicity. METHODS Click- and pure-tone-evoked auditory brainstem responses (ABRs) in young CBA/J mice were measured. The first phase consisted of a dosing study to identify the optimal cisplatin dose for ototoxicity. In the next phase, ABR thresholds were measured in cisplatin-treated mice after 5 days of IT injection of 24 mg/ml of dexamethasone in 1 ear and normal saline in the opposite ear to serve as controls. RESULTS Intraperitoneal injection of 14 mg/kg of cisplatin induces significant hearing loss (click-evoked ABR threshold elevation = 12 +/- 7 dB, mu +/- standard error of the mean) with acceptable mortality (20%). The ears that received IT dexamethasone in cisplatin-treated mice had minimal ABR threshold shifts with the click, 8 and 16 kHz of stimuli. There was no significant difference between IT dexamethasone and IT saline ears at 32 kHz. CONCLUSION IT dexamethasone protected the mouse ear against cisplatin-induced ototoxicity in a frequency-dependent manner. The present results suggest that IT dexamethasone may be a safe, simple, and effective intervention that minimizes cisplatin ototoxicity without interfering with the chemotherapeutic actions of cisplatin.
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Zuur C. Hearing loss due to low-dose cisplatin chemoradiation head and neck cancer. Radiother Oncol 2009. [DOI: 10.1016/j.radonc.2008.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Liao XB, Yan SX. Efficacy of low-dose cisplatin-based chemo-irradiation in assessing hearing loss for locally advanced head and neck cancer. Radiother Oncol 2008; 90:282, author reply 282-3. [PMID: 19042049 DOI: 10.1016/j.radonc.2008.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 11/01/2008] [Indexed: 11/18/2022]
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Zuur CL, Simis YJW, Verkaik RS, Schornagel JH, Balm AJM, Dreschler WA, Rasch CRN. Hearing loss due to concurrent daily low-dose cisplatin chemoradiation for locally advanced head and neck cancer. Radiother Oncol 2008; 89:38-43. [PMID: 18706728 DOI: 10.1016/j.radonc.2008.06.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 06/04/2008] [Accepted: 06/18/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Cisplatin-based chemo-irradiation (CRT) is increasingly used for head and neck squamous cell carcinoma (HNSCC). We aimed to assess hearing deterioration due to low-dose cisplatin chemoradiation and to compare the observed hearing loss with hearing loss in our previously described high-dose cisplatin CRT cohort. MATERIALS AND METHODS A prospective analysis of hearing thresholds at low and (ultra)-high frequencies obtained before and after treatment in 60 patients. Patients received low-dose cisplatin (6mg/m(2), daily infusions, 20-25 days) with concomitant accelerated radiotherapy (70Gy). RESULTS Audiometry up to 16kHz was performed before therapy and 31 days (median) post-treatment. The total incidence of ototoxicity in CTCAEv3.0 was 31% in audiograms up to 8kHz, and 5% of ears tested qualified for HAs due to treatment. The mean hearing loss at speech frequencies was 2.6dB (SD 5.7) and 2.3dB (SD 9.2) at PTA 1-2-4kHz air-conduction and bone-conduction, respectively. The mean hearing loss at ultra-high frequencies (PTA AC 8-10-12.5kHz) was 9.0dB (SD 8.1). Low-dose cisplatin CRT caused less acute hearing loss (CTCAE 31%), compared to high-dose cisplatin CRT (CTCAE 78%). CONCLUSIONS Low-dose cisplatin chemo-irradiation for HNSCC is a relatively safe treatment protocol with respect to ototoxicity.
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Affiliation(s)
- Charlotte L Zuur
- Department of Head and Neck Surgery, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:175-82. [DOI: 10.1097/moo.0b013e3282fd9415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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