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Abstract

PURPOSE:

Patients treated with cranial radiation therapy (RT) are at risk for sensorineural hearing loss (SNHL). Although SNHL is often characterized as a delayed consequence of anticancer therapy, longitudinal reports of SNHL in childhood cancer survivors treated with contemporary RT are limited. We report the incidence, onset, severity, and long-term trajectory of SNHL among children receiving RT. Potential risk factors for SNHL were also identified.

PATIENTS AND METHODS:

Serial audiologic testing was conducted on 235 pediatric patients who were treated with conformal or intensity-modulated RT as part of an institutional phase II trial for localized primary brain tumors, including craniopharyngioma, ependymoma, and juvenile pilocytic astrocytoma. All but one patient had measurable cochlear radiation dose (CRD) greater than 0 Gy. The median follow-up from RT initiation to latest audiogram was 9 years with a median of 11 post-RT audiograms per patient. Audiograms were classified by the Chang Ototoxicity Grading Scale. Progression was defined by an increase in Chang grade from SNHL onset to the most recent evaluation.

RESULTS:

At last evaluation, SNHL was prevalent in 14% of patients: 2.1% had mild and 11.9% had significant SNHL requiring hearing aids. Median time from RT to SNHL onset was 3.6 years (range, 0.4 to 13.2 years). Among 29 patients with follow-up evaluations after SNHL onset, 65.5% experienced continued decline in hearing sensitivity in either ear and 34.5% had no change. Younger age at RT initiation (hazard ratio [HR], 2.32; 95% CI, 1.21 to 4.46), higher CRD (HR, 1.07; 95% CI, 1.03 to 1.11), and cerebrospinal fluid shunting (HR, 2.02; 95% CI, 1.07 to 3.78) were associated with SNHL.

CONCLUSION:

SNHL is a late effect of RT that likely worsens over time. Long-term audiologic follow-up for a minimum of 10 years post-RT is recommended.

Author information

Bass JK1, Hua CH2, Huang J2, Onar-Thomas A2, Ness KK2, Jones S2, White S2, Bhagat SP2, Chang KW2, Merchant TE2.​

1Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA. johnnie.bass@stjude.org.

2Johnnie K. Bass, Chia-Ho Hua, Jie Huang, Arzu Onar-Thomas, Kirsten K. Ness, Skye Jones, Stephanie White, Shaum P. Bhagat, and Thomas E. Merchant, St Jude Children's Research Hospital; Johnnie K. Bass and Shaum P. Bhagat, University of Memphis, Memphis TN; and Kay W. Chang, Stanford University, Stanford, CA.