Ototoxicity evaluation in medulloblastoma patients treated with involved field boost using intensity-modulated radiation therapy (IMRT): a retrospective review

Radiation Oncology

Antonio Sergio Petrilli¹  Vicente Odone Filho³  Wladimir Nadalin²  Rodrigo Morais Hanriot⁴  Robson Ferrigno⁴  Maria Ines Rabelo Gonçalves⁵  Liliane Desgualdo Pereira⁵  Andrea Maria Cappellano¹  Nasjla Saba da Silva¹  Michael Jenwei Chen⁴  Eduardo Weltman²  Wilson Albieri Vieira² 

[1] Department of pediatric oncology, Instituto de Oncologia Pediátrica/Grupo de Apoio ao Adolescente e à Criança com Câncer/Universidade Federal de São Paulo-IOP/GRAACC/UNIFESP, São Paulo, Brazil;Departament of Radiation Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo-HCFMUSP, São Paulo, Brazil;Department of pediatric oncology, Instituto de tratamento do cancer infantil (ITACI) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo-HCFMUSP, São Paulo, Brazil;Department of Radiation Oncology, Hospital Israelita Albert Einstein-HIAE, São Paulo, Brazil;Department of speech therapy, Instituto de Oncologia Pediátrica/Grupo de Apoio ao Adolescente e à Criança com Câncer/Universidade Federal de São Paulo-IOP/GRAACC/UNIFESP, São Paulo, Brazil

关键词: Quality of life;    Cisplatin;    Intensity-modulated radiotherapy;    Hearing loss;    Medulloblastoma;   

Others  :  1132074
DOI  :  10.1186/1748-717X-9-158

 received in 2014-04-22, accepted in 2014-07-07,  发布年份 2014

【 摘 要 】

Background

Ototoxicity is a known side effect of combined radiation therapy and cisplatin chemotherapy for the treatment of medulloblastoma. The delivery of an involved field boost by intensity modulated radiation therapy (IMRT) may reduce the dose to the inner ear when compared with conventional radiotherapy. The dose of cisplatin may also affect the risk of ototoxicity. A retrospective study was performed to evaluate the impact of involved field boost using IMRT and cisplatin dose on the rate of ototoxicity.

Methods

Data from 41 medulloblastoma patients treated with IMRT were collected. Overall and disease-free survival rates were calculated by Kaplan-Meier method Hearing function was graded according to toxicity criteria of Pediatric Oncology Group (POG). Doses to inner ear and total cisplatin dose were correlated with hearing function by univariate and multivariate data analysis.

Results

After a mean follow-up of 44 months (range: 14 to 72 months), 37 patients remained alive, with two recurrences, both in spine with CSF involvement, resulting in a disease free-survival and overall survival of 85.2% and 90.2%, respectively.

Seven patients (17%) experienced POG Grade 3 or 4 toxicity. Cisplatin dose was a significant factor for hearing loss in univariate analysis (p < 0.03). In multivariate analysis, median dose to inner ear was significantly associated with hearing loss (p < 0.01). POG grade 3 and 4 toxicity were uncommon with median doses to the inner ear bellow 42 Gy (p < 0.05) and total cisplatin dose of less than 375 mg/m² (p < 0.01).

Conclusions

IMRT leads to a low rate of severe ototoxicity. Median radiation dose to auditory apparatus should be kept below 42 Gy. Cisplatin doses should not exceed 375 mg/m².

【 授权许可】

   
2014 Vieira et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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