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

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

Author Vieira, Wilson Albieri Google Scholar
Weltman, Eduardo Google Scholar
Chen, Michael Jenwei Google Scholar
Silva, Nasjla Saba da Autor UNIFESP Google Scholar
Cappellano, Andrea Maria Autor UNIFESP Google Scholar
Pereira, Liliane Desgualdo Autor UNIFESP Google Scholar
Gonçalves, Maria Inês Rebelo Autor UNIFESP Google Scholar
Ferrigno, Robson Google Scholar
Hanriot, Rodrigo Morais Google Scholar
Nadalin, Wladimir Google Scholar
Odone Filho, Vicente Google Scholar
Petrilli, Antonio Sergio Autor UNIFESP Google Scholar
Institution Hosp Israelita Albert Einstein HIAE
Universidade de São Paulo (USP)
Universidade Federal de São Paulo (UNIFESP)
Abstract 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/m(2) (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/m(2).
Keywords Medulloblastoma
Hearing loss
Intensity-modulated radiotherapy
Cisplatin
Quality of life
Language English
Sponsor Instituto Israelita de Responsabilidade Social (IIRS) of Hospital Israelita Albert Einstein (HIAE)
Date 2014-07-21
Published in Radiation Oncology. London: Biomed Central Ltd, v. 9, 6 p., 2014.
ISSN 1748-717X (Sherpa/Romeo, impact factor)
Publisher Biomed Central Ltd
Extent 6
Origin http://dx.doi.org/10.1186/1748-717X-9-158
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000339593300001
URI http://repositorio.unifesp.br/handle/11600/37996

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