Comparison of Auditory Effects after IMRT with Concurrent Cisplatin for Locally Advanced Head and Neck Cancer

Abstract

Introduction: Head and neck cancer is among the most common malignancies in developing countries like India. The treatment modality for head and neck cancers is usually radiotherapy which can be used either after surgery or combined with chemotherapy. However, radiation therapy can damage the ear from pharyngotympanic tube to the auditory pathway upto brain-stem, causing hearing loss due to ultrastructural changes in organ of corti. Long term survivors can experience Sensorineural Hearing Loss (SNHL) due to the combined ototoxic effects of radiotherapy and cisplatin. Aim: To study the effects of Intensity-Modulated Radiation Therapy (IMRT) along with chemotherapy on hearing, in head and neck cancer patients. Materials and Methods: Twenty three patients were treated on Linear Accelerator- Varian Unique Performance with 6 MV photon and received dose 70 Gy in 35 fractions over 6.5 weeks; either by sequential IMRT (SEQ) or by Simultaneous Integrated Boost IMRT (SIB). They also received cisplatin 35 mg/m2 once weekly concurrently with radiotherapy for 6-8 weeks. Pre and post-radiotherapy Pure Tone Audiometry (PTA) were done to assess the hearing loss. Results: Most of our patients developed either conductive hearing loss or mixed hearing loss. Only two patients developed sensorineural hearing loss. Conclusion: Most of the patients developed mild hearing loss before and after chemoradiotherapy, indicating that both the arms of IMRT (radiotherapy) did not have any major influence on the inner ear.

Keywords

• chemoradiotherapy
• hearing loss
• radiotherapy