Researchers say they have identified factors associated with treatment-related hearing loss in children with cancer.

The team has incorporated these factors into an online calculator that may help oncologists estimate the risk and severity of hearing loss.

The researchers described this work in the Journal of Clinical Oncology.1


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The team retrospectively evaluated 171 children with central nervous system (CNS) or head and neck cancer. The patients had received radiotherapy (RT), with or without chemotherapy, and had longitudinal audiologic evaluation.

The median time from diagnosis to the first audiogram was 0.1 years (range, -8.5 to 4.4 years), and the median time to the last audiogram was 3.1 years (range, 0.1 to 15.2 years). The median number of audiograms was 6 (range, 2-23).

Results

In a multivariate analysis, the following factors were associated with increasing grade of hearing loss:

  • Time since RT, per year (odds ratio [OR], 1.21; P <.001)
  • Mean cochlea dose, per Gy (OR, 1.04; P <.001)
  • Being younger than 3.0 years of age at RT (OR, 2.42; P =.051)
  • Cisplatin dose, per 100 mg/m2 (OR, 1.48; P <.001)
  • Carboplatin dose, per 1000 mg/m2 (OR, 1.41; P =.002).

No significant synergistic interactions were found between RT and cisplatin (P =.53) or RT and carboplatin (P =.85). This suggests RT and platinum chemotherapy have an additive effect on hearing loss, according to the researchers.

At 5 years after RT, the cumulative incidence of high-frequency hearing loss (> 4 kHz) was 50% or greater if the mean cochlea dose was greater than 30 Gy. The incidence of hearing loss across all frequencies continued to increase beyond 5 years after RT.

Clinical Implications

Based on their findings, the researchers proposed that a mean cochlea dose of 30 Gy or less could reduce the risk of hearing loss. The team recommended a lower threshold (20-25 Gy) for patients also receiving platinum chemotherapy.

The researchers also recommended that children at increased risk of hearing loss undergo regular audiologic surveillance and be given an early referral for assistive devices and neurocognitive evaluation if hearing loss is detected.

In addition, the researchers created a nomogram to model the risk of severe hearing loss. It includes the aforementioned variables associated with hearing loss in the multivariate analysis — age younger than 3 years at RT, mean cochlea dose, years since RT, cisplatin dose, and carboplatin dose.

The nomogram has been adapted into a computer-based calculator, which is available for download at UTORweb.2

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

References

  1. Keilty D, Khandwala M, Liu ZA, et al. Hearing loss after radiation and chemotherapy for CNS and head-and-neck tumors in children. J Clin Oncol. Published online September 27, 2021. doi:10.1200/JCO.21.00899
  2. UTORweb, Tsang DS, Ahmed S. Hearing Loss Calculator in Children. http://individual.utoronto.ca/dtsang/hearing/HLcalc_11.xlsm