gms | German Medical Science

33. Wissenschaftliche Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie (DGPP)

Deutsche Gesellschaft für Phoniatrie und Pädaudiologie e. V.

Regensburg, 22.09. - 25.09.2016

Radiation fraction dose and hearing impairment: retrospective analysis of high-frequency hearing loss in 19 medulloblastoma patients treated with conventionally-fractionated or hyperfractionated radiotherapy

Poster

  • corresponding author presenting/speaker Ross Parfitt - Department of Phoniatrics and Pedaudiology, University Hospital Münster, Münster, Deutschland
  • Sergiu Scobioala - Clinic for Radiooncology, University Hospital Münster, Münster, Deutschland
  • Mohammed Channaoui - Clinic for Radiooncology, University Hospital Münster, Münster, Deutschland
  • Heidi Wolters - Clinic for Radiooncology, University Hospital Münster, Münster, Deutschland
  • Hans Theodor Eich - Clinic for Radiooncology, University Hospital Münster, Münster, Deutschland
  • Antoinette am Zehnhoff-Dinnesen - Department of Phoniatrics and Pedaudiology, University Hospital Münster, Münster, Deutschland

Deutsche Gesellschaft für Phoniatrie und Pädaudiologie. 33. Wissenschaftliche Jahrestagung der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie (DGPP). Regensburg, 22.-25.09.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP5

doi: 10.3205/16dgpp13, urn:nbn:de:0183-16dgpp133

Veröffentlicht: 8. September 2016

© 2016 Parfitt et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Abstract

Background: This study compares high frequency hearing loss (HF HL) in medulloblastoma patients receiving conventionally-fractionated (CRT) and hyperfractionated radiotherapy (HRT).

Materials and methods: Between 2008 and 2015, 19 children with medulloblastoma, mean age 5.5 years (range 15 months – 17.5 years), were treated sequentially with radiotherapy and cisplatin-based chemotherapy (HIT 2000 protocol). 12 patients received CRT (35.2 Gy (1.6 Gy x 5 per week) to the craniospinal axes (CSA) and 55 Gy (1.8 Gy x 5 per week) to the posterior cranial fossa (PCF)). 7 patients received HRT (1 Gy x 2 per day x 5 per week) of 40 Gy (CSA), 60 Gy (PCF) and 68 Gy (primary tumor site). Post-radiotherapy HL was determined by audiological testing and classified according to the “Münster classification”.

Results: Post-treatment bilateral HL was observed in all patients. In the CRT group, grade 2 HL (worst threshold >20 dB HL at ≥4 kHz) was found in 8 patients (66%) and grade 3 (>20 dB HL at <4 kHz) was found in 4 patients (34%). Hearing losses of grades 2 and 3 were found in 3 (43%) and 4 (57%) patients respectively after HRT. The average cochlear dose (Dmean) for CRT was 45.4 Gy (right) and 44.9 Gy (left), and 56 Gy (right) and 55.1 Gy (left) for HRT (P>.05 for both ears). No linear correlation between severity of HL and number of cisplatin cycles was observed.

Conclusion: The higher average cochlear dose of hyperfractionated cranial radiotherapy appears to be associated with more severe hearing loss in medulloblastoma patients. Further investigations to establish an optimal radiation treatment modality are necessary because of the rarity of medulloblastoma.


Text

Background

Children with malignant brain tumours are often treated with cranial radiotherapy and platin-based chemotherapy, which can lead to high-frequency sensorineural hearing loss (HF SNHL) (eg. Bhandare et al. [1]). Key factors include the cochlear dose of radiotherapy [2], [3] and the temporal relationship and dose of cisplatin chemotherapy [4], [5]. Hyperfractionated radiotherapy (HRT) involves more frequent application of lower doses, including multiple doses on the same day. Lannering et al. [6] found no significant difference in hearing thresholds at follow-up between conventionally-fractionated (CRT) and hyperfractionated cranial radiotherapy, but Gupta et al. [7] reported better audiological outcomes following HRT. The present retrospective study compares HF SNHL in medulloblastoma patients receiving conventionally-fractionated (CRT) and hyperfractionated radiotherapy (HRT).

Materials and methods

Between 2008 and 2015, 19 children with medulloblastoma, mean age 5.5 years (range 15 months – 17.5 years), were treated sequentially with radiotherapy and cisplatin-based chemotherapy following the HIT 2000 protocol. 12 patients received CRT of 35.2 Gy (1.6 Gy × 5 per week) to the craniospinal axes (CSA) and 55 Gy (1.8 Gy × 5 per week) to the posterior cranial fossa (PCF)). 7 patients received HRT (1 Gy × 2 per day × 5 per week) of 40 Gy to the CSA, 60 Gy to the PCF and 68 Gy to the primary tumor site. Post-radiotherapy hearing thresholds were determined by audiological testing and classified according to the Münster classification scheme, which is sensitive to minimally-raised thresholds in the higher-frequencies [8].

Results

Post-treatment bilateral SNHL was observed in all patients. In the CRT group, grade 2 SNHL (worst threshold >20 dB HL at ≥4 kHz) was found in 8 patients (66%) and grade 3 (>20 dB HL at <4 kHz) was found in 4 patients (34%). Hearing losses of grades 2 and 3 were found in 3 (43%) and 4 (57%) patients respectively after HRT. The average cochlear dose (Dmean) for CRT was 45.4 Gy (right) and 44.9 Gy (left), and 56 Gy (right) and 55.1 Gy (left) for HRT (P>.05 for both ears). No linear correlation between severity of SNHL and number of cisplatin cycles was observed.

Discussion

Our results point in the opposite direction to Gupta et al. [7], who found lower incidence of hearing loss following HRT. Gupta et al’s participants, however, were treated with radiotherapy alone. The combined role of cisplatin and cranial radiotherapy needs further investigation. As a retrospective study, the time course of treatment and audiological outcome in our study could not be uniformly controlled across patients.

Conclusion

The higher average cochlear dose found to result from hyperfractionated cranial radiotherapy appears to be associated with more severe hearing loss in medulloblastoma patients. Further investigations to establish an optimal radiation treatment modality are necessary in order to improve treatment for patients with medulloblastoma.


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