Hearing Loss Risk in Pediatric Patients Treated with Cranial Irradiation and Cisplatin-Based Chemotherapy.
Hearing Loss Risk in Pediatric Patients Treated with Cranial Irradiation and Cisplatin-Based Chemotherapy.
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DOI：
10.1016/j.ijrobp.2021.02.050
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发表时间：
2021-08-01
期刊：
影响因子：
--
通讯作者：
Orgel E
中科院分区：
文献类型：
--
作者：
Cohen-Cutler S;Wong K;Mena V;Sianto K;Wright MA;Olch A;Orgel E
颅脑放射治疗 (RT) 和基于顺铂的化疗对于治疗许多儿科癌症至关重要，但会导致严重的耳毒性。本研究的目的是确定放疗剂量与接受顺铂治疗的儿科患者随后发生听力损失的风险之间的关系。这项针对顺铂治疗的儿科患者的回顾性研究检查了颅脑放疗的耳毒性。根据国际儿科肿瘤学会 (SIOP) 共识耳毒性量表对每只耳朵的耳毒性进行分级。使用平均、中值、最大和最小接收剂量计算耳蜗的 RT 剂量，以确定听力损失的最预测参数。然后，多变量逻辑回归模型检查了听力损失的危险因素。在接受 RT+顺铂治疗的 96 名儿童（161 只耳朵）中，最小耳蜗 RT 剂量最能预测听力损失。较高的耳蜗放疗剂量与听力损失增加相关（每增加 10 Gy 剂量，比值比 [OR] = 1.64，p = 0.043），接受自体骨髓移植 (aBMT) 的患者风险增加（HR = 10.47，p < 0.001）。这项研究支持进一步测试最小耳蜗放疗剂量，作为耳毒性风险更具预测性的剂量参数。耳蜗放疗剂量会增加因基于顺铂的化疗而导致听力损失的风险。接触 aBMT 是发生听力损失的最强预测因素，在所有耳蜗剂量下，这些儿童面临特别高的听力损失风险。未来的前瞻性研究对于进一步了解放疗剂量阈值并最大限度地降低儿童癌症幸存者听力损失的风险至关重要。
Cranial radiation therapy (RT) and cisplatin-based chemotherapy are essential to treating many pediatric cancers but cause significant ototoxicity. The objective of this study is to determine the relationship of RT dose with risk for subsequent hearing loss in pediatric patients treated with cisplatin. This retrospective study of cisplatin-treated pediatric patients examined ototoxicity from cranial RT. Ototoxicity was graded for each ear according to International Society of Pediatric Oncology (SIOP) consensus ototoxicity scale. RT dose to cochlea was calculated using mean, median, maximum, and minimum dose received to determine most predictive parameter for hearing loss. Multivariable logistic regression models then examined risk factors for hearing loss. In 96 children (161 ears) treated with RT+cisplatin, minimum cochlear RT dose was most predictive of hearing loss. Higher cochlear RT dose was associated with increased hearing loss (Odds Ratio [OR] per 10 Gy dose increase = 1.64, p = 0.043), with added risk in those receiving an autologous bone marrow transplantation (aBMT) (HR = 10.47, p < 0.001). This research supports further testing of minimum cochlear RT dose as a more predictive dose parameter for risk of ototoxicity. Cochlear RT dose was additive to risk of hearing loss from underlying cisplatin-based chemotherapy. Exposure to aBMT was the strongest predictor of developing hearing loss, placing these children at particularly high risk for hearing loss across all cochlear doses. Future prospective studies are crucial to further inform RT dose thresholds and minimize risk of hearing loss in childhood cancer survivors.
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影响因子：
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发表时间：
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影响因子：
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