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Model predicts hearing loss after chemoradiotherapy for head and neck cancer
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A model composed of patient and treatment characteristics predicted hearing level after chemoradiotherapy for patients with head and neck cancer, according to results of a retrospective cohort study.
Although cisplatin chemoradiotherapy is the preferred organ-sparing therapy for patients with advanced head and neck cancer, radiation damage to the inner ear may cause adverse effects such as hearing loss or tinnitus.
Despite previous research on risk factors for these and other ototoxic effects, researchers have only been able to identify subjective expectations for post-treatment hearing loss. These clinical recommendations are based on personal experience and result in less-effective patient counselling.
Eleonoor A. R. Theunissen, MD, an oncologist at The Netherlands Cancer Institute in Amsterdam, and colleagues sought to develop a statistical model that would predict treatment-induced hearing loss following cisplatin infusions that would allow for evidence-based patient counselling. Researchers considered variables known to influence the severity of ototoxicity, such as increasing radiation dose to the cochlea, increasing cumulative cisplatin dose and baseline hearing level.
The analysis included data from 156 patients who received high-dose concomitant chemoradiotherapy as a primary treatment for head and neck cancer between 1997 and 2011. Researchers excluded some patients from the statistical analysis: 15 were missing the exact radiation dose to the cochlea and 41 were missing data on post-treatment pure-tone audiometry.
Nineteen other patients had a hearing level of at least 35 dB for at least 1 ear — the hearing level that reflects criteria for a hearing aid in the Netherlands — before the treatment and were excluded from the model validation.
Patients received a total cisplatin dose ranging from 315 mg to 600 mg (median, 546 mg) and a radiation dose to the cochlea ranging from 1.1 Gy to 70.9 Gy (median, 13.6 Gy).
Using data from the 81 patients included in the model validation, researchers calculating the statistical model predicts a hearing level above and below 35 dB with an area under the receiver operating characteristic curve of 0.68, a 29% sensitivity (95% CI, 13-51) and a 97% specificity (95% CI, 88-100). These data equated to a 78% positive predictive value.
“In practical terms, sensitivity is the probability that a patient who will eventually need a hearing aid is predicted to need it,” the researchers wrote. “In reverse, specificity indicates a true-negative prediction. The positive predictive value is the probability that a person with a positive prediction will need a hearing aid whereas a negative predictive value is the probability that a person with a negative prediction will not need a hearing aid.”
Still, more research is necessary, the researchers wrote.
“Our prediction model is a step toward improving individual counselling of patients with head and neck cancer who are at risk for [cisplatin chemoradiotherapy]-related hearing loss,” the researchers concluded. “However, future research concerning more variables as risk factors for hearing loss is needed.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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