Chemoradiation-induced hearing loss remains a major concern for head and neck cancer patients.
Nicole C Schmitt, Brandi R Page
PMID 28728452WHAT IT FOUND
High-dose cisplatin chemoradiation for head and neck cancer often causes hearing loss and tinnitus.
Weekly low-dose cisplatin with intensity-modulated radiation therapy may be less damaging, but studies are small. Audiograms before and after treatment should be offered.
Key findings
01High-dose cisplatin chemoradiation has been reported to cause hearing loss in 17 to 88% of patients, depending on how studies define it.
02In a study of 22 patients receiving low-dose weekly cisplatin with intensity-modulated radiation therapy, there was no hearing loss at low frequencies and threshold shifts were 0 to 20 dB, mean 5.2 dB at 4 to 8 kHz, but 10 patients could not complete all six cycles.
03Pre-treatment and post-treatment audiograms should be offered to all HNSCC patients treated with chemoradiation, and patients should be counseled about treatment-related hearing loss.
STILL TO COME
How it was doneWhat they found
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What it does not show
The review summarizes studies that are small and use different definitions of hearing loss, so the true incidence is hard to compare across studies. The newer low-dose weekly cisplatin with intensity-modulated radiation therapy is supported by small studies and anecdotal reports, not large direct comparisons. The authors' own practice observations are not a prospective study and cannot establish how common hearing loss is now. It does not provide definitive incidence or severity of hearing loss with modern low-dose chemoradiation.
Declared interests
The authors declared no conflicts of interest. The publication types list NIH intramural research support.
The easy way to misread this
Do not read the lower hearing-loss findings for weekly low-dose cisplatin with intensity-modulated radiation therapy as proof that the regimen is safer. The paper says the shift is based on small studies and anecdotal reports, and it calls for larger prospective study.