The relevance of ototoxicity induced by radiotherapy

Yan Huang; Hong Zhou; Fenglan An; Aimei Zhao; Jian Wu; Meihua Wang; Judong Luo

doi:10.1186/s13014-023-02268-7

The relevance of ototoxicity induced by radiotherapy

Radiat Oncol. 2023 Jun 3;18(1):95. doi: 10.1186/s13014-023-02268-7.

Authors

Yan Huang^#^{1

2}, Hong Zhou^#³, Fenglan An⁴, Aimei Zhao⁵, Jian Wu⁶, Meihua Wang⁷, Judong Luo⁸

Affiliations

¹ Department of Radiotherapy, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical Center, Nanjing Medical University, Changzhou, China.
² Department of Head and Neck Surgery, Graduate School of Dalian Medical University, Dalian, China.
³ Department of Otolaryngology, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China.
⁴ The Third Department of Internal Medicine, Hospital of Traditional Chinese Medicine, Lingcheng, Dezhou, Shandong Province, China.
⁵ Department of Obstetrics and Gynecology, Dongchangfu Maternal and Child Health Hospital of Liaocheng, Liaocheng, China.
⁶ Department of Head and Neck Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China.
⁷ Department of Pathology, Changzhou Tumor Hospital, Changzhou, China. wangmeihua1234@suda.edu.cn.
⁸ Department of Radiotherapy, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Medical Center, Nanjing Medical University, Changzhou, China. judongluo@163.com.

^# Contributed equally.

Abstract

Background: The risk of ototoxicity, characterized by hearing impairment, tinnitus, or middle ear inflammation, is elevated in both child and adult cancer survivors who have undergone head-neck or brain radiation, or a combination of the two. To provide optimal care for these cancer survivors and minimize subsequent complications, it is crucial to comprehend the relationship between radiotherapy and ototoxicity.

Methods: A comprehensive search of databases, including the Cochrane Library, PubMed, Embase, and Web of Science, was conducted from the inception of the knowledge base up until January 2023. The metafor-package was employed to compare ototoxicity rates in individuals receiving radiotherapy. Two independent assessors extracted data and analyzed targets using a random-effects model.

Results: Out of the 28 randomized controlled trials (RCTs) included in the analysis, 25 were prospective RCTs. Subgroup analysis revealed that mean cochlear radiation dose, primary tumor location, radiotherapy modality, and patient age significantly influenced total hearing impairment. Intensity-modulated radiotherapy was associated with less ototoxicity than 2D conventional radiotherapy (OR, 0.53; 95% CI, 0.47-0.60; P = 0.73; I² = 0%). Stereotactic radiotherapy appeared to be a superior option for hearing preservation compared to radiosurgery (OR, 1.44; 95% CI, 1.00-2.07; P = 0.69; I² = 0%). Children demonstrated a higher risk of hearing impairment than adults. More than 50% of patients with vestibular neuroadenoma experienced hearing impairment following radiation therapy. A strong association was observed between the average cochlear radiation dose and hearing impairment. Increased cochlear radiation doses may result in a heightened risk of hearing impairment.

Conclusion: Several risk factors for radiation-induced hearing impairment were identified in this study. High cochlear radiation doses were found to exacerbate the risk of hearing impairment resulting from radiation therapy.

Keywords: Cochlea; Ototoxicity; Radiation dose; Radiation exposure; Radiotherapy.

Publication types

Systematic Review

MeSH terms

Adult
Child
Hearing / radiation effects
Hearing Loss* / etiology
Humans
Ototoxicity* / complications
Radiosurgery* / adverse effects
Radiotherapy / adverse effects
Radiotherapy, Intensity-Modulated* / adverse effects

Abstract

Publication types

MeSH terms

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