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Anschuetz L, Ermiş E, Gebhart I, Stalder O, Raabe A, Mantokoudis G, Caversaccio M, Hermann E, Wagner F, Vibert D. Vestibular Schwannoma: Long-term Outcome of the Vestibular Function After Stereotactic Radiosurgery. OTOLOGY & NEUROTOLOGY OPEN 2023; 3:e038. [PMID: 38515641 PMCID: PMC10950146 DOI: 10.1097/ono.0000000000000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/12/2023] [Indexed: 03/23/2024]
Abstract
Objective Evaluation at long term of the impact of the stereotactic surgery (SRS) on the vestibular function in vestibular schwannoma (VS) patients. Study design and setting Retrospective study in a tertiary referral center. Patients Fifty-one VS patients were included (34 females;17 males), aged from 41 to 78 years treated exclusively with SRS. Intervention Vestibular function was assessed before SRS and with median time interval of 14 (FU1) and 25 (FU2) months after treatment. Vestibular evaluation included: history, clinical vestibular examination, videonystagmography, head impulse test (v-HIT) and cervical vestibular evoked myogenic potentials (c-VEMPS). Results Before SRS, caloric testing (Caloric) was impaired in 77%; after treatment, in 92% (FU1) and 77% (FU2). Lateral HIT was decreased in 22% before SRS, in 39% at FU1 and FU2. C-VEMPS were absent in 50% before SRS, in 76% at FU1 and, FU2. Before SRS, no statistically significant association was found between asymptomatic and symptomatic patients with respect to the results of Caloric, v-HIT and c-VEMPS. This lack of association was also seen after SRS, at FU1 and FU2. Conclusion Our study showed that the impairment of the vestibular function might be attributed to the VS itself as well as to the radiation of the inner ear during SRS. The lateral SSC at low frequencies and the saccular function seem to be more involved with the time.
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Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Ekin Ermiş
- Department of Radiation-Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Isabel Gebhart
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Andreas Raabe
- Department of Neurosurgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Evelyne Hermann
- Department of Radiation-Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Dominique Vibert
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Gorelyshev S, Medvedeva O, Mazerkina N, Ryzhova M, Krotkova O, Golanov A. Medulloblastomas in Pediatric and Adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:117-152. [PMID: 37452937 DOI: 10.1007/978-3-031-23705-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Medulloblastoma is the primary malignant embryonic tumor of the cerebellum and the most common malignant tumor of childhood, accounting up to 25% of all CNS tumors in children, but is extremely rare in adults. Despite the fact that medulloblastomas are one of the most malignant human tumors, it is worthy to note that a great breakthrough has been achieved in our understanding of oncogenesis and the development of real methods of treatment. The main objective of surgical treatment is a maximum resection of tumor with minimal impairment of neurological functions, in order to reduce the volume, remove tumor tissue, get the biopsy, and restore the cerebrospinal fluid flow. The progress of surgical techniques (using a microscope, ultrasound suction), anesthesiology, and intensive care has significantly decreased surgical mortality and increased radicality of tumor removal. Postoperative mortality is less than one percent in most studies, while neurological complications have been reported between 5-10%. Radiotherapy is the main method of treatment in patients older than 3 years, which dramatically improved the recurrence-free survival. Nevertheless, the radiation therapy without systemic chemotherapy leads to a high risk of systemic metastases. After the role of chemotherapy was statistically proven, investigations of the optimal combination of different chemotherapy regimens continued around the world. Currently, 80% of patients can already be cured, however, the quality of life of patients in the long-term period remains quite low, which depends on many factors including endocrinological, cognitive, neurological, and otoneurologic aspects. Thus, the main strategic goal of the development of neuro-oncology is to reduce the doses of radiation therapy to the CNS and the main task of international research is to optimize existing protocols and develop fundamentally new ones based on molecular genetic research in order to improve the quality of life.
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Affiliation(s)
- Sergey Gorelyshev
- Pediatric Neurosurgical Department, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia.
| | - Olga Medvedeva
- Pediatric Neurosurgical Department, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
| | - Nadezhda Mazerkina
- Pediatric Neurosurgical Department, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
| | - Marina Ryzhova
- Department of Neuropathology, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
| | - Olga Krotkova
- N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
| | - Andrey Golanov
- Department of Radiosurgery, N.N. Burdenko National Medical Research Centre of Neurosurgery, Moscow, Russia
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Tien CT, Chen CN, Young YH. Post-irradiation endolymphatic hydrops vs. post-irradiation sudden deafness. Radiother Oncol 2022; 176:222-227. [PMID: 36265683 DOI: 10.1016/j.radonc.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Increasing numbers of acute sensorineural hearing loss (SNHL) are recently experienced in irradiated nasopharyngeal carcinoma (NPC) survivors. AIM This study adopted MR imaging to differentiate between post-irradiation sudden deafness (PISD) and post-irradiation endolymphatic hydrops (PIEH) in long-term NPC survivors with acute SNHL. METHODS From 2012 to 2021, consecutive 10 irradiated NPC survivors with acute SNHL were enrolled. All patients underwent an inner ear test battery and MR imaging using HYDROPS-Mi2 technique. Six patients (11 ears) with positive cochlear hydrops on MR images were diagnosed as PIEH, while another 4 patients (4 ears) without cochlear hydrops on MR images were referred to PISD. RESULTS The interval from the onset of NPC to acute SNHL did not significantly differ between the PIEH (10 ± 6 years) and PISD (8 ± 2 years). No significant difference was found between the two disorders from any of the symptomatic, radiotherapeutic, audiological, or vestibular perspective. Interestingly, most (5/6) patients with PIEH had bilateral involvement, while all (4/4) patients with PISD showed unilateral affliction. A significantly declining sequence of abnormality rates in the inner ear test battery was noted in the PIEH patients, running from the audiometry (100%), cervical vestibular-evoked myogenic potential (VEMP) test (100%), ocular VEMP test (73%), to the caloric test (36%). However, such declining trend was not observed in patients with PISD. CONCLUSION When facing an NPC survivor who had acute SNHL over a prolonged period after irradiation, MR imaging using HYDROPS-Mi2 technique should be performed to differentiate the PIEH from the PISD, since both disorders have various treatment modalities and hearing outcome.
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Affiliation(s)
- Chung-Tang Tien
- Departments of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Nan Chen
- Departments of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ho Young
- Departments of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
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Liu Z, Luo Y, Guo R, Yang B, Shi L, Sun J, Guo W, Gong S, Jiang X, Liu K. Head and Neck Radiotherapy Causes Significant Disruptions of Cochlear Ribbon Synapses and Consequent Sensorineural Hearing Loss. Radiother Oncol 2022; 173:207-214. [DOI: 10.1016/j.radonc.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
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Ismail O, Sobhy O, Assal S, Sanghera P, Begg P, Irving R. Comparing Hearing Outcomes in Irradiated and Conservatively Managed Vestibular Schwannoma. Otol Neurotol 2022; 43:e374-e381. [PMID: 35061638 DOI: 10.1097/mao.0000000000003457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compare hearing outcome for vestibular schwannoma patients following stereotactic radiosurgery (SRS) or conservative management. STUDY DESIGN Retrospective review. SETTING University Hospital. PATIENTS Patients with small- or medium-sized sporadic vestibular schwannoma (intracanalicular or with CPA component <2 cm) who were managed conservatively or underwent SRS with available clinical, radiological, and audiometric data from the time of presentation (or just before radiotherapy for the SRS group) and most recent follow-up; with the two sets of data to be compared being at least 3 years apart (minimum follow-up period). INTERVENTIONS SRS or observation. MAIN OUTCOME MEASURE Pure-tone averages, speech discrimination scores, and corresponding hearing classifications. RESULTS Two hundred forty-seven patients met our inclusion criteria; 140 were managed conservatively with a mean follow-up period of 5.9 ± 1.6 years and 107 underwent SRS with a mean follow-up period of 7.1 ± 1.9 years. There was significant deterioration of hearing measures for both groups; with the SRS group displaying consistently worse measures. SRS patients showed worse mean pure-tone averages and speech discrimination scores decline rates by 2.72 dB/yr and 2.98 %/yr, respectively, when compared with conservatively managed patients. Stratifying patients according to Tokyo's hearing classification revealed that 68.75% of conservatively managed patients who had baseline serviceable hearing preserved their hearing throughout the studied period compared with only 15.38% of the SRS patients. CONCLUSION Based on our data we conclude that patients with small- and medium-sized tumors will have a better hearing outcome if managed via an initial conservative approach with radiotherapy reserved for those demonstrating disease progression.
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Affiliation(s)
- Omneya Ismail
- Otolaryngology Department-Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Otolaryngology Department-Audiovestibular Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ossama Sobhy
- Otolaryngology Department-Audiovestibular Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samir Assal
- Otolaryngology Department-Audiovestibular Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Paul Sanghera
- Clinical Oncology Department, Queen Elizabeth Hospital Birmingham
| | - Philip Begg
- Otolaryngology Department-Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- The Royal Orthopaedic Hospital NHS Foundation Trust
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Richard Irving
- Otolaryngology Department-Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Tawfik KO, Khan UA, Friedman RA. Treatment of Small Vestibular Schwannomas. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mahdavi SR, Rezaeyan A, Nikoofar A, Bakhshandeh M, Farahani S, Cheraghi S. Comparison of radiation and chemoradiation-induced sensorineural hearing loss in head and neck cancer patients. J Cancer Res Ther 2020; 16:539-545. [PMID: 32719264 DOI: 10.4103/jcrt.jcrt_891_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim The purpose of this study was to assess and compare the incidence and severity of sensorineural hearing loss (SNHL) in head-and-neck patients undergoing radiotherapy (RT) and concurrent cisplatin-based chemoradiotherapy (CRT). Materials and Methods Pure tone audiometry (PTA) was performed at 0.25-12 kHz on 35 RT and 25 CRT patients after 12-month followed up. The hearing loss was evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) criteria. Results SNHL increased to 84% in patients who had received CRT, compared with 26% increasing in patients who had treated with RT. There was an increased risk of SNHL at all frequencies for ears received a cochlear mean dose >50 Gy in RT group, compared to those receiving cochlear mean dose >30 Gy in CRT group. SNHL was more severe at higher frequencies in both patient groups. Conclusion Characteristic of radiation-induced SNHL is different from CRT-induced SNHL, especially in threshold radiation dose and PTA frequency.
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Affiliation(s)
- Seied Rabi Mahdavi
- Radiation Biology Research Center; Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abolhasan Rezaeyan
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikoofar
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiation Technology, Allied Medicine Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Farahani
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Susan Cheraghi
- Radiation Biology Research Center; Department of Radiation Sciences, Allied Medicine Faculty, Iran University of Medical Sciences, Tehran, Iran
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Chang H, Tu TY, Wu CS, Kuo TY, Huang CY. Is the risk of idiopathic sudden sensorineural hearing loss higher in nasopharyngeal carcinoma than in hypopharyngeal cancer? A population-based study. J Chin Med Assoc 2020; 83:865-869. [PMID: 32221154 PMCID: PMC7478193 DOI: 10.1097/jcma.0000000000000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the risk of developing sudden sensorineural hearing loss (SSHL) in patients with hypopharyngeal cancer with that in patients with nasopharyngeal carcinoma (NPC). METHODS A population-based, retrospective cohort study was performed using the Taiwan National Health Research Database databank. Patients selected for this study were diagnosed with hypopharyngeal cancer or NPC and treated with radiotherapy in the period from 2001 to 2004. Routine follow-up was conducted for 8 years (2004-2012), and the incidence of SSHL was calculated at the final follow-up. RESULTS There was no significant difference in the risk of developing SSHL between the hypopharyngeal cancer group and its control group (p = 1.000). In hypopharyngeal cancer and NPC groups, the rates of SSHL were 0.12% and 1.00%, respectively (p < 0.001). The cumulative hazard of SSHL during the follow-up period was significantly higher in the NPC group than in the control group (p < 0.001). CONCLUSION Radiotherapy in patients with hypopharyngeal cancer did not increase the risk of developing SSHL, but postirradiation NPC was significantly associated with an increased incidence of SSHL.
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Affiliation(s)
- Hung Chang
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzong-Yang Tu
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chuan-Song Wu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan, ROC
- College of Science and Engineering, and Graduate School of Business Administration, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Ting-Yu Kuo
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chii-Yuan Huang
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Address correspondence. Dr. Chii-Yuan Huang, Department of Otolaryngology, Head & Neck Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (C.-Y. Huang)
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Bass JK, Huang J, Hua CH, Bhagat SP, Mendel LL, Onar-Thomas A, Indelicato DJ, Merchant TE. Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma. Am J Audiol 2018; 27:306-315. [PMID: 30073327 DOI: 10.1044/2018_aja-18-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/18/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Compared to photon-based radiotherapy, protons deliver less radiation to healthy tissue resulting in the potential reduction of late complications such as sensorineural hearing loss (SNHL). We report early auditory outcomes in children treated with proton radiotherapy (PRT) for craniopharyngioma. METHOD Conventional frequency (CF = 0.25-8.0 kHz) audiometry, extended high-frequency (EHF = 9.0-16.0 kHz) audiometry, distortion product otoacoustic emission (DPOAE) testing, and speech-in-noise (SIN) assessments were prospectively and longitudinally conducted on 74 children with a median of 2 post-PRT evaluations (range, 1-5) per patient. The median age at PRT initiation was 10 years, and median follow-up time was 2 years. Ototoxicity was classified using the Chang Ototoxicity Grading Scale (Chang & Chinosornvatana, 2010) and the American Speech-Language-Hearing Association (ASHA) criteria (ASHA, 1994). Comparisons were made between baseline and most recent DPOAE levels, with evidence of ototoxicity based on criterion reductions of ≥ 6 dB. The critical difference values for comparing SIN scores between two conditions (i.e., pre- and post-PRT) were used to determine a significant change between test scores. RESULTS At last evaluation, no patients had SNHL in the CF range, and 2 patients had SNHL (Chang Grade 1a) in the EHF range. Based on the ASHA criteria, a decrease in hearing was observed in 0 patients in the CF range alone, in 9 patients in the EHF range alone, and in 15 patients in both the CF and EHF ranges. DPOAE levels decreased at a faster rate at higher versus lower frequencies. For 41 evaluable patients, SIN perception did not decline over time (p = .6463). CONCLUSION At a median follow-up time of 2 years post-PRT, normal hearing was maintained within the CF range. However, subclinical decreases in hearing were observed, particularly in the EHF range and in the DPOAE level; thus, long-term follow-up is recommended to monitor for potential auditory late effects from PRT.
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Affiliation(s)
- Johnnie K. Bass
- Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN
| | - Jie Huang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Shaum P. Bhagat
- Department of Communication Disorders and Sciences, San Jose State University, CA
| | - Lisa Lucks Mendel
- School of Communication Sciences and Disorders, University of Memphis, TN
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Thomas E. Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
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Irradiated ears in nasopharyngeal carcinoma survivors: A review. Laryngoscope 2018; 129:637-642. [DOI: 10.1002/lary.27303] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 01/22/2023]
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Mutations in Cockayne Syndrome-Associated Genes (Csa and Csb) Predispose to Cisplatin-Induced Hearing Loss in Mice. J Neurosci 2017; 36:4758-70. [PMID: 27122034 DOI: 10.1523/jneurosci.3890-15.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/16/2016] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Cisplatin is a common and effective chemotherapeutic agent, yet it often causes permanent hearing loss as a result of sensory hair cell death. The causes of sensitivity to DNA-damaging agents in nondividing cell populations, such as cochlear hair and supporting cells, are poorly understood, as are the specific DNA repair pathways that protect these cells. Nucleotide excision repair (NER) is a conserved and versatile DNA repair pathway for many DNA-distorting lesions, including cisplatin-DNA adducts. Progressive sensorineural hearing loss is observed in a subset of NER-associated DNA repair disorders including Cockayne syndrome and some forms of xeroderma pigmentosum. We investigated whether either of the two overlapping branches that encompass NER, transcription-coupled repair or global genome repair, which are implicated in Cockayne syndrome and xeroderma pigmentosum group C, respectively, modulates cisplatin-induced hearing loss and cell death in the organ of Corti, the auditory sensory epithelium of mammals. We report that cochlear hair cells and supporting cells in transcription-coupled repair-deficient Cockayne syndrome group A (Csa(-/-)) and group B (Csb(-/-)) mice are hypersensitive to cisplatin, in contrast to global genome repair-deficient Xpc(-/-) mice, both in vitro and in vivo We show that sensory hair cells in Csa(-/-) and Csb(-/-) mice fail to remove cisplatin-DNA adducts efficiently in vitro; and unlike Xpc(-/-) mice, Csa(-/-) and Csb(-/-) mice lose hearing and manifest outer hair cell degeneration after systemic cisplatin treatment. Our results demonstrate that Csa and Csb deficiencies predispose to cisplatin-induced hearing loss and hair/supporting cell damage in the mammalian organ of Corti, and emphasize the importance of transcription-coupled DNA repair in the protection against cisplatin ototoxicity. SIGNIFICANCE STATEMENT The utility of cisplatin in chemotherapy remains limited due to serious side effects, including sensorineural hearing loss. We show that mouse models of Cockayne syndrome, a progeroid disorder resulting from a defect in the transcription-coupled DNA repair (TCR) branch of nucleotide excision repair, are hypersensitive to cisplatin-induced hearing loss and sensory hair cell death in the organ of Corti, the mammalian auditory sensory epithelium. Our work indicates that Csa and Csb, two genes involved in TCR, are preferentially required to protect against cisplatin ototoxicity, relative to global genome repair-specific elements of nucleotide excision repair, and suggests that TCR is a major force maintaining DNA integrity in the cochlea. The Cockayne syndrome mice thus represent a model for testing the contribution of DNA repair mechanisms to cisplatin ototoxicity.
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Espenel S, Garcia MA, Guy JB, Vallard A, Ben Mrad M, Langrand-Escure J, El Meddeb Hamrouni A, Trone JC, Xia Y, Rancoule C, Magné N. Ototoxicité radio-induite et chimio-induite dans les cancers ORL : de la prévention primaire à la prévention tertiaire. Cancer Radiother 2017; 21:77-83. [DOI: 10.1016/j.canrad.2016.08.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 12/21/2022]
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Lambert EM, Gunn GB, Gidley PW. Effects of radiation on the temporal bone in patients with head and neck cancer. Head Neck 2016; 38:1428-35. [PMID: 27453348 DOI: 10.1002/hed.24267] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/21/2015] [Accepted: 09/03/2015] [Indexed: 11/06/2022] Open
Abstract
Radiotherapy is a key component in the treatment of many head and neck cancers, and its potential to cause long-term adverse effects has become increasingly recognized. In this review, we describe the short-term and long-term sequelae of radiation-associated changes in and injury to the temporal bone and its related structures. The pathophysiology of radiation-induced injury and its clinical entities, including sensorineural hearing loss, chronic otitis media, osteoradionecrosis, and radiation-associated malignancies, are described. We also discuss radiation dose to the head and neck as it relates to these conditions. An improved understanding of radiation's effects on the temporal bone will enable physicians and researchers to continue efforts to reduce radiotherapy-related sequelae and guide clinicians in diagnosing and treating the various otologic conditions that can arise in patients with head and neck cancer who have received radiotherapy. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1428-1435, 2016.
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Affiliation(s)
- Elton M Lambert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Bass JK, Hua CH, Huang J, Onar-Thomas A, Ness KK, Jones S, White S, Bhagat SP, Chang KW, Merchant TE. Hearing Loss in Patients Who Received Cranial Radiation Therapy for Childhood Cancer. J Clin Oncol 2016; 34:1248-55. [PMID: 26811531 DOI: 10.1200/jco.2015.63.6738] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Johnnie K Bass
- Johnnie 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.
| | - Chia-Ho Hua
- Johnnie 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
| | - Jie Huang
- Johnnie 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
| | - Arzu Onar-Thomas
- Johnnie 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
| | - Kirsten K Ness
- Johnnie 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
| | - Skye Jones
- Johnnie 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
| | - Stephanie White
- Johnnie 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
| | - Shaum P Bhagat
- Johnnie 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
| | - Kay W Chang
- Johnnie 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
| | - Thomas E Merchant
- Johnnie 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
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Chi FH, Young YH. Inner ear deficits in irradiated nasopharyngeal carcinoma survivors. Laryngoscope 2015; 125:2565-71. [DOI: 10.1002/lary.25329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/02/2015] [Accepted: 03/23/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Fan-Hsiang Chi
- Department of Otolaryngology; National Taiwan University Hospital, Yun-Lin Branch; Dou-Liou
| | - Yi-Ho Young
- Department of Otolaryngology; National Taiwan University Hospital; Taipei Taiwan
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Bezdjian A, Mujica-Mota MA, Devic S, Daniel SJ. The Effect of Radiotherapy on Gentamicin Ototoxicity. Otolaryngol Head Neck Surg 2015; 152:1094-101. [DOI: 10.1177/0194599815573197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/27/2015] [Indexed: 11/15/2022]
Abstract
Objective Patients undergoing radiotherapy (RT) often present with serious bacterial infections requiring the use of antibiotic treatment. Gentamicin is a commonly used aminoglycoside antibiotic, whose ototoxicity remains a major problem in clinical use. The objective of this study was to determine whether radiation exposure can influence gentamicin-induced ototoxicity. Study Design Prospective animal study. Setting Animal care facilities of the Montreal Children’s Hospital Research Institute. Methods Sixteen guinea pigs received low-dose RT unilaterally for 4 weeks (total: 48 Gy). Animals then received low or high doses of gentamicin (40 mg/kg/d and 80 mg/kg/d) for 10 days. The ears were divided into 4 groups: gentamicin 40 mg, gentamicin 80 mg, gentamicin 40 mg + RT, and gentamicin 80 + RT. Auditory brainstem responses and distortion products otoacoustic emissions were assessed at baseline and before and after gentamicin treatment. Cochlear morphology using light and scanning electron microscopy were evaluated. Results High-dose gentamicin caused significant auditory brainstem response threshold shifts ( P = .020), with greater hearing loss in the irradiated ear (difference of 23.6 + 7.5 dB). All animals exposed to high-dose gentamicin had head tilts toward the radiated side. Cochlear morphology revealed the greatest hair cell damage in the gentamicin 80 + RT group followed by gentamicin 80. Conclusion Results suggest that radiation can exacerbate the ototoxicity of gentamicin at high doses.
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Affiliation(s)
- Aren Bezdjian
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada
- Department of Otolaryngology–Head and Neck Surgery, The Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Mario A. Mujica-Mota
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada
- Department of Otolaryngology–Head and Neck Surgery, The Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Slobodan Devic
- Medical Physics Unit, McGill University, Montréal, Quebec, Canada
- Department of Radiation Oncology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Sam J. Daniel
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada
- Department of Otolaryngology–Head and Neck Surgery, The Montreal Children’s Hospital, Montreal, Quebec, Canada
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Mujica‐Mota MA, Ibrahim FF, Bezdjian A, Devic S, Daniel SJ. The effect of fractionated radiotherapy in sensorineural hearing loss: An animal model. Laryngoscope 2014; 124:E418-24. [DOI: 10.1002/lary.24756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/15/2014] [Accepted: 05/06/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Mario A. Mujica‐Mota
- McGill Auditory Sciences LaboratoryThe Montreal Children's HospitalMontréal Quebec Canada
- Department of Otolaryngology–Head and Neck SurgeryThe Montreal Children's HospitalMontréal Quebec Canada
| | - Farid F. Ibrahim
- McGill Auditory Sciences LaboratoryThe Montreal Children's HospitalMontréal Quebec Canada
- Department of Otolaryngology–Head and Neck SurgeryThe Montreal Children's HospitalMontréal Quebec Canada
| | - Aren Bezdjian
- McGill Auditory Sciences LaboratoryThe Montreal Children's HospitalMontréal Quebec Canada
- Department of Otolaryngology–Head and Neck SurgeryThe Montreal Children's HospitalMontréal Quebec Canada
| | - Slobodan Devic
- McGill Auditory Sciences LaboratoryThe Montreal Children's HospitalMontréal Quebec Canada
- Medical Physics UnitMcGill UniversityThe Montreal Children's Hospital, Montréal Quebec Canada
- Department of Radiation OncologyJewish General HospitalThe Montreal Children's HospitalMontréal Quebec Canada
| | - Sam J. Daniel
- McGill Auditory Sciences LaboratoryThe Montreal Children's HospitalMontréal Quebec Canada
- Department of Otolaryngology–Head and Neck SurgeryThe Montreal Children's HospitalMontréal Quebec Canada
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18
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Mechanisms of radiation-induced sensorineural hearing loss and radioprotection. Hear Res 2014; 312:60-8. [DOI: 10.1016/j.heares.2014.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/12/2014] [Accepted: 03/07/2014] [Indexed: 12/20/2022]
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Jacob JT, Carlson ML, Schiefer TK, Pollock BE, Driscoll CL, Link MJ. Significance of Cochlear Dose in the Radiosurgical Treatment of Vestibular Schwannoma. Neurosurgery 2014; 74:466-74; discussion 474. [DOI: 10.1227/neu.0000000000000299] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Cochlear dose has been identified as a potentially modifiable contributor to hearing loss after stereotactic radiosurgery (SRS) for vestibular schwannoma (VS).
OBJECTIVE:
To evaluate the association between computed tomography-based volumetric cochlear dose and loss of serviceable hearing after SRS, to assess intraobserver and interobserver reliability when determining modiolar point dose with the use of magnetic resonance imaging and computed tomography, and to discuss the clinical significance of the cochlear dose with regard to radiosurgical planning strategy.
METHODS:
Patients with serviceable pretreatment hearing who underwent SRS for sporadic VS between the use of Gamma Knife Perfexion were studied. Univariate and multivariate associations with the primary outcome of time to nonserviceable hearing were evaluated.
RESULTS:
A total of 105 patients underwent SRS for VS during the study period, and 59 (56%) met study criteria and were analyzed. Twenty-one subjects (36%) developed nonserviceable hearing at a mean of 2.2 years after SRS (SD, 1.0 years; median, 2.1 years; range 0.6-3.8 years). On univariate analysis, pretreatment pure tone average, speech discrimination score, American Academy of Otolaryngology-Head and Neck Surgery hearing class, marginal dose, and mean dose to the cochlear volume were statistically significantly associated with time to nonserviceable hearing. However, after adjustment for baseline differences, only pretreatment pure tone average was statistically significantly associated with time to nonserviceable hearing in a multivariable model.
CONCLUSION:
Cochlear dose is one of many variables associated with hearing preservation after SRS for VS. Until further studies demonstrate durable tumor arrest with reduced dose protocols, routine tumor dose planning should not be modified to limit cochlear dose at the expense of tumor control.
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Affiliation(s)
- Jeffrey T. Jacob
- Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Matthew L. Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Terry K. Schiefer
- Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Bruce E. Pollock
- Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Colin L. Driscoll
- Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Michael J. Link
- Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
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Lin C, Lin SW, Weng SF, Lin YS. Risk of developing sudden sensorineural hearing loss in patients with nasopharyngeal carcinoma: A population-based cohort study. Head Neck 2013; 36:203-8. [DOI: 10.1002/hed.23278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 11/12/2022] Open
Affiliation(s)
- Charlene Lin
- Department of Molecular and Cell Biology; University of California; Berkeley, Berkeley California
| | - Shih-Wei Lin
- Faculty of Pharmaceutical Sciences; University of British Columbia; British Columbia Canada
| | - Shih-Feng Weng
- Department of Medical Research; Chi Mei Medical Center; Tainan Taiwan
- Department of Hospital and Health Care Administration; Chia-Nan University of Pharmacy and Science; Tainan Taiwan
| | - Yung-Song Lin
- Department of Otolaryngology; School of Medicine; Taipei Medical University; Taipei Taiwan
- Department of Otolaryngology; Chi Mei Medical Center; Tainan Taiwan
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Schacht J, Talaska AE, Rybak LP. Cisplatin and aminoglycoside antibiotics: hearing loss and its prevention. Anat Rec (Hoboken) 2012; 295:1837-50. [PMID: 23045231 DOI: 10.1002/ar.22578] [Citation(s) in RCA: 243] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 07/24/2012] [Indexed: 12/19/2022]
Abstract
This review introduces the pathology of aminoglycoside antibiotic and the cisplatin chemotherapy classes of drugs, discusses oxidative stress in the inner ear as a primary trigger for cell damage, and delineates the ensuing cell death pathways. Among potentially ototoxic (damaging the inner ear) therapeutics, the platinum-based anticancer drugs and the aminoglycoside antibiotics are of critical clinical importance. Both drugs cause sensorineural hearing loss in patients, a side effect that can be reproduced in experimental animals. Hearing loss is reflected primarily in damage to outer hair cells, beginning in the basal turn of the cochlea. In addition, aminoglycosides might affect the vestibular system while cisplatin seems to have a much lower likelihood to do so. Finally, based on an understanding the mechanisms of ototoxicity pharmaceutical ways of protection of the cochlea are presented.
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Affiliation(s)
- Jochen Schacht
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, Michigan 48109-5616, USA.
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Gopal KV, Wu C, Shrestha B, Campbell KCM, Moore EJ, Gross GW. d-Methionine protects against cisplatin-induced neurotoxicity in cortical networks. Neurotoxicol Teratol 2012; 34:495-504. [PMID: 22732230 DOI: 10.1016/j.ntt.2012.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 06/10/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
Abstract
Cisplatin is a platinum-based chemotherapeutic agent widely used for the treatment of various types of cancer. Patients undergoing cisplatin treatment often suffer from a condition known as "chemobrain", ototoxicity, peripheral neuropathy, weight loss, nausea, vomiting, nephrotoxicity, seizures, hearing loss and tinnitus. d-Methionine (d-Met), a sulfur-containing nucleophilic antioxidant, has been shown to prevent cisplatin-induced side effects in animals without antitumor interference. In this study, we have used an in vitro model of cortical networks (CNs), enriched in auditory cortex cells; to quantify cisplatin neurotoxicity and the protective effects of d-Met. Dissociated neurons from auditory cortices of mouse embryos were grown on microelectrode arrays with 64 transparent indium-tin oxide electrodes, which enabled continuous optical and electrophysiological monitoring of network neurons. Cisplatin at 0.10-0.25 mM induced up to a 200% increase in spontaneous spiking activity, while concentrations at or above 0.5mM caused irreversible loss of neuronal activity, accompanied by cell death. Pretreatment with d-Met, at a concentration of 1.0mM, prevented the cisplatin-induced excitation at 0.10-0.25 mM, caused sustained excitation without occurrence of cell death at 0.5mM, and delayed cell death at 0.75 mM cisplatin. l-Methionine, the optical isomer, showed lower potency and less efficacy than d-Met, was less protective against 0.1mM cisplatin, and proved ineffective at a concentration of 0.5mM cisplatin. Pre-exposure time of d-Met was associated with the protective effects at 0.1 and 0.5mM cisplatin, with longer pre-exposure times exhibiting better protection. This study quantifies as a function of concentration and time that d-Met protects central nervous system tissue from acute cisplatin toxicity.
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Affiliation(s)
- Kamakshi V Gopal
- University of North Texas, Department of Speech & Hearing Sciences, United States.
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Hansasuta A, Choi CYH, Gibbs IC, Soltys SG, Tse VCK, Lieberson RE, Hayden MG, Sakamoto GT, Harsh GR, Adler JR, Chang SD. Multisession stereotactic radiosurgery for vestibular schwannomas: single-institution experience with 383 cases. Neurosurgery 2012; 69:1200-9. [PMID: 21558974 DOI: 10.1227/neu.0b013e318222e451] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Single-session stereotactic radiosurgery (SRS) treatment of vestibular schwannomas results in excellent tumor control. It is not known whether functional outcomes can be improved by fractionating the treatment over multiple sessions. OBJECTIVE To examine tumor control and complication rates after multisession SRS. METHODS Three hundred eighty-three patients treated with SRS from 1999 to 2007 at Stanford University Medical Center were retrospectively reviewed. Ninety percent were treated with 18 Gy in 3 sessions, targeting a median tumor volume of 1.1 cm3 (range, 0.02-19.8 cm3). RESULTS During a median follow-up duration of 3.6 years (range, 1-10 years), 10 tumors required additional treatment, resulting in 3- and 5-year Kaplan-Meier tumor control rates of 99% and 96%, respectively. Five-year tumor control rate was 98% for tumors < 3.4 cm3. Neurofibromatosis type 2-associated tumors were associated with worse tumor control (P = .02). Of the 200 evaluable patients with pre-SRS serviceable hearing (Gardner-Robertson grade 1 and 2), the crude rate of serviceable hearing preservation was 76%. Smaller tumor volume was associated with hearing preservation (P = .001). There was no case of post-SRS facial weakness. Eight patients (2%) developed trigeminal dysfunction, half of which was transient. CONCLUSION Multisession SRS treatment of vestibular schwannomas results in an excellent rate of tumor control. The hearing, trigeminal nerve, and facial nerve function preservation rates reported here are promising.
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Affiliation(s)
- Ake Hansasuta
- Division of Neurological Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Cochlear implantation in patients with neurofibromatosis type 2 and patients with vestibular schwannoma in the only hearing ear. Int J Otolaryngol 2012; 2012:157497. [PMID: 22518152 PMCID: PMC3299335 DOI: 10.1155/2012/157497] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 12/02/2011] [Indexed: 11/17/2022] Open
Abstract
Cochlear implants are a new surgical option in the hearing rehabilitation of patients with neurofibromatosis type 2 (NF2) and patients with vestibular schwannoma (VS) in the only hearing ear. Auditory brainstem implant (ABI) has been the standard surgical treatment for these patients. We performed a literature review of patients with NF2 and patients with VS in the only hearing ear. Cochlear implantation (CI) provided some auditory benefit in all patients. Preservation of cochlear nerve integrity is crucial after VS resection. Results ranged from environmental sound awareness to excellent benefit with telephone use. Promontory stimulation is recommended although not crucial. MRI can be performed safely in cochlear implanted patients.
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Prospective study on the dose distribution to the acoustic structures during postoperative 3D conformal radiotherapy for parotid tumors: dosimetric and audiometric aspects. Strahlenther Onkol 2011; 187:350-6. [PMID: 21603994 DOI: 10.1007/s00066-011-2170-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE To analyze dose distribution in the hearing organ and to evaluate the dose effect on the hearing thresholds in patients treated with post-parotidectomy 3-dimensional conformal radiotherapy (3D-CRT). METHODS AND MATERIALS A total of 17 patients received post-parotidectomy 3D-CRT (median dose: 63 Gy). The audiometric evaluation comprised pure tone audiometry and tympanometry performed before radiotherapy (RT) and 3, 6, and 24 months after RT. The ear structures were delineated on planning computer tomography scans. Mean and maximum doses were calculated and dose-volume histograms were plotted. RESULTS Before RT, the median baseline audiometric thresholds were normal. At 3 months post-RT, 3 patients were diagnosed as having middle ear underpressure and/or effusion that resolved completely by 6 months. During 2-year follow-up, none of the ears showed perceptive hearing loss at speech frequencies. The mean doses at ipsilateral external auditory canal, mastoids cells, tympanic case, Eustachian tube, semicircular canals, and cochlea were 44.8 Gy, 39.0 Gy, 30.9 Gy, 33.0 Gy, 19.6 Gy, and 19.2 Gy, respectively. The doses to the contralateral ear were negligible, except for the Eustachian tube (up to 28.2 Gy). CONCLUSION Post-parotidectomy 3D-CRT is associated with relatively low doses to the ear and the surrounding structures. Post-RT audiometry did not show any permanent (neither conductive nor perceptive) hearing impairment. Only in 3 patients were there signs of transient unilateral dysfunction of the Eustachian tube observed during the first few months after RT. Longer follow-up and larger patient series are warranted to confirm these preliminary findings.
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Abstract
INTRODUCTION A nonbehavioral method for monitoring ototoxicity in patients treated with cisplatin is needed because patients enduring chemotherapy may not be well or cooperative enough to undergo repeated hearing tests. Distortion-product otoacoustic emissions (DPOAEs) provide a nonbehavioral measure of auditory function that is sensitive to cisplatin exposure. However, interpreting DPOAE findings in the context of ototoxicity monitoring requires that their accuracy be determined in relation to a clinically accepted gold standard test. OBJECTIVES Among patients receiving cisplatin for the treatment of cancer, we sought to (1) identify the combination of DPOAE metrics and ototoxicity risk factors that best classified ears with and without ototoxic-induced hearing changes; and (2) evaluate the test performance achieved by the composite measure as well as by DPOAEs alone. DESIGN Odds of experiencing hearing changes at a given patient visit were determined using data collected prospectively from 24 Veterans receiving cisplatin. Pure-tone thresholds were examined within an octave of each subject's high-frequency hearing limit. DPOAE were collected as a set of four response growth (input/output) functions near the highest f2 frequency that yielded a robust response at L2 = L1 = 65 dB SPL. Logistic regression modeled the risk of hearing change using several DPOAE metrics, drug treatment factors, and other patient factors as independent variables. An optimal discriminant function was derived by reducing the model so that only statistically significant variables were included. Receiver operating characteristic curve analyses were used to evaluate test performance. RESULTS At higher cisplatin doses, ears with better hearing at baseline were more likely to exhibit ototoxic hearing changes than those with poorer hearing. Measures of pre-exposure hearing, cumulative drug dose, and DPOAEs generated a highly accurate discriminant function with a cross-validated area under the receiver operating characteristic curve of 0.9. DPOAEs alone also provided an indication of ototoxic hearing change when measured at the highest DPOAE test frequency that yielded a robust response. CONCLUSIONS DPOAEs alone and especially in combination with pre-exposure hearing and cisplatin dose provide an indication of whether or not hearing has changed as a result of cisplatin administration. These promising results need to be validated in a separate sample.
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Abstract
OBJECTIVE Human mutations in the DNA repair genes, Xeroderma pigmentosum (XP)-C and XPA result in hearing loss, which has fueled the hypothesis that there is a significant demand for these genes in protecting cochlear genetic material. Therefore, we quantified the level of XPC and XPA mRNA in the mammalian cochlea. DESIGN XPC and XPA mRNAs were purified from the cochlea of 15 Fischer344 rats and quantified using SYBR Green chemistry. Another 15 Fischer344 rats were sacrificed for immunolocalization of XPC and XPA polypeptides in the cochlea and kidney (control organ). RESULTS XP mRNA levels were up to 95% (XPA) and 69% (XPC) of the respective maximum expression capacity of each gene. In addition, these cochlear levels were up to sixfold (XPC) and threefold (XPA) greater than that of the kidney, which is known to exhibit XP-DNA repair activity that is greater than most organs of the body. Immunohistochemistry revealed that most kidney and cochlear cells were immunopositive. CONCLUSION These data suggest that under normal conditions the cochlea is experiencing persistent genomic stress that helps to explain the hypersensitivity of the cochlea to exogenous stressors (ototoxic xenobiotics and/or acoustic-overexposure) as well as provide a basis to interpret hearing loss among patients with XP.
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Fleury B, Lapeyre M. [Tolerance of normal tissues to radiation therapy: ear]. Cancer Radiother 2010; 14:284-9. [PMID: 20605506 DOI: 10.1016/j.canrad.2010.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 02/18/2010] [Indexed: 11/29/2022]
Abstract
The main objective of this work was to describe, based on a literature survey, the radiation-induced toxicity of the ear and to try to establish the limiting dose. The limiting toxicity was the sensorineural hearing loss. A dose-effect relationship has been described by several authors. Thirty to 40% of patients who are irradiated for head and neck cancer are concerned, but the intensity of the hearing loss tends to depend on the exact localisation of the primary tumour: nasopharyngeal irradiations, paranasal sinusal and parotid irradiation are at greater risk of complication. High frequencies are more vulnerable than the lower ones. Age of patients, as well as baseline hearing abilities, deeply influence the issue. As far as possible, the dose to the inner ear--the cochlea more precisely--should be kept under 40 Gy. In case of association with other causes of toxicity (such as age, low baseline value, association to cisplatin), this dose should be as low as possible. Should carcinologic constraints lead to toxic doses, then patients should be properly informed.
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Affiliation(s)
- B Fleury
- Département de Radiothérapie, Centre Léon-Bérard, 28 rue Laënnec, 69008 Lyon, France.
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Lessa RM, Aparecido de Oliveira JA, Rossato M, Netto TG. Analysis of the cytoprotective effect of amifostine on the irradiated inner ear of guinea pigs: an experimental study. Braz J Otorhinolaryngol 2010; 75:694-700. [PMID: 19893938 PMCID: PMC9442262 DOI: 10.1016/s1808-8694(15)30520-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 11/06/2008] [Indexed: 11/29/2022] Open
Abstract
Radiation can cause damage to the inner ear, from a simple hearing loss all the way to profound deafness. Amifostine is a cytoprotective substance extensively used during radio-chemotherapy for malignant tumors. Aim the objective of the present investigation was to establish the antioxidant and radioprotective effects of amifostine on the organ of Corti of albino guinea pigs irradiated in the head and neck region. Materials and Methods An experimental study conducted on four groups of guinea pigs were used; One group received only amifostine, one group was submitted to a single dose of 350 cGy and the other two were similarly irradiated but received amifostine doses of 100 or 200 mg/kg. All animals were slaughtered 30 days after the experiment, their bullae were removed and the damaged outer hair cells were counted. Result The extent of injury was lower in the outer hair cells of the two groups treated with amifostine compared to the group that was only irradiated. There was no difference between the group treated with 100 and 200 mg/kg of amifostine. The group that received only amifostine had no cochlear damage. Conclusion Amifostine is an effective cytoprotective substance in the Organ of Corti of irradiated guinea pigs.
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Affiliation(s)
- Ricardo Miranda Lessa
- PhD, Assistant Physician - University Hospital - University of São Paulo (USP) Medical School at Ribeirão Preto
- Send correspondence to: Hospital das Clínicas da USP Ribeirão Preto 12° andar Av. dos Bandeirantes 3900 Campus Universitário Monte Alegre 14048-900 Ribeirão Preto São Paulo
| | - José Antônio Aparecido de Oliveira
- Associate Professor. Retired Full Professor - Department of Otorhinolaryngology and Head and Neck Surgery - University of São Paulo (USP) Medical School at Ribeirão Preto
| | - Maria Rossato
- Lab Technician - Department of Otorhinolaryngology and Head and Neck Surgery - University of São Paulo (USP) Medical School at Ribeirão Preto
| | - Thomaz Ghilardi Netto
- Associate Professor, Coordinator of the Technical and Administrative Activities of the Radiotherapy Service - University of São Paulo Hospital - Ribeirão Preto. Department of Otorhinolaryngology and Head and Neck Surgery - University of São Paulo (USP) Medical School at Ribeirão Preto
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Roland JT, Cosetti M, Liebman T, Waltzman S, Allen JC. Cochlear implantation following treatment for medulloblastoma. Laryngoscope 2010; 120:139-43. [PMID: 19693928 DOI: 10.1002/lary.20669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Medulloblastoma is the most common pediatric malignant tumor of the central nervous system in children. Treatment includes surgical excision, external beam radiation, and multiagent chemotherapy. Otologic sequelae are common and may result from radiation and/or chemotherapy. Profound sensorineural hearing loss (SNHL) is a known complication of neuro-oncologic treatment and may render these patients eligible for cochlear implantation (CI). Issues of CI in this population, including diagnosis, treatment of preoperative middle ear disease, operative and postoperative course, performance data, and long-term tumor surveillance are highlighted and reviewed. STUDY DESIGN Retrospective chart review. METHODS Three patients treated for pediatric medulloblastoma with surgical resection, postoperative hyperfractioned craniospinal radiotherapy, and multiagent adjuvant chemotherapy who underwent cochlear implantation were identified. Details of neuro-oncologic treatment and associated otologic complications are presented and analyzed. Primary outcome assessment includes treatment of middle ear pathology, perioperative cochlear implant course, and postimplantation performance data. RESULTS Each patient required surgical treatment of chronic ear disease 4 to 16 years after chemoradiation. All progressed to profound SNHL and were implanted 8 to 17 years post-neuro-oncologic treatment. There were no intraoperative complications, and full insertion of the cochlear implant electrode array was achieved in each patient. One patient developed postoperative wound dehiscence requiring operative closure. Postimplantation performance data support significant benefit in all patients. CONCLUSIONS Patients treated for pediatric medulloblastoma develop otologic sequelae, including profound SNHL, and may require cochlear implantation. Successful management of middle ear and mastoid pathology involves consideration of potential future cochlear implantation. Postoperative performance data supports cochlear implantation in this population.
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Affiliation(s)
- J Thomas Roland
- Department of Otolaryngology, New York University Langone Medical Center, New York, New York, USA.
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Bhandare N, Mendenhall WM, Antonelli PJ. Radiation Effects on the Auditory and Vestibular Systems. Otolaryngol Clin North Am 2009; 42:623-34. [DOI: 10.1016/j.otc.2009.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sensorineural Hearing Loss After Treatment of Nasopharyngeal Carcinoma: A Longitudinal Analysis. Int J Radiat Oncol Biol Phys 2009; 73:1335-42. [DOI: 10.1016/j.ijrobp.2008.07.034] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2008] [Revised: 07/07/2008] [Accepted: 07/08/2008] [Indexed: 11/18/2022]
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Oldenburg J, Fosså SD, Ikdahl T. Genetic variants associated with cisplatin-induced ototoxicity. Pharmacogenomics 2009; 9:1521-30. [PMID: 18855538 DOI: 10.2217/14622416.9.10.1521] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cisplatin induces ototoxicity with a huge interindividual variation, which is at least partly based on genetic differences between the affected individuals. Identification of genetic variants that could predict the severity of ototoxicity is an important step towards a more individualized cisplatin treatment. Nevertheless, so far, only a few studies have assessed this issue. This review will address the prevalence of cisplatin-induced ototoxicity, its pathophysiology, quantification and associations with genetic variants. The recent progress in both phenotyping and genotyping is discussed.
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Affiliation(s)
- Jan Oldenburg
- Department of Clinical Cancer Research, The Norwegian Radium Hospital, Rikshospitalet, Montebello, 0310 Oslo, Norway.
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Factors Affecting Sensitivity of Distortion-Product Otoacoustic Emissions to Ototoxic Hearing Loss. Ear Hear 2008; 29:875-93. [DOI: 10.1097/aud.0b013e318181ad99] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guthrie OW. Preincision complex-I from the excision nuclease reaction among cochlear spiral limbus and outer hair cells. J Mol Histol 2008; 39:617-25. [DOI: 10.1007/s10735-008-9202-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 10/14/2008] [Indexed: 12/01/2022]
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Guthrie OW, Li-Korotky HS, Durrant JD, Balaban C. Cisplatin induces cytoplasmic to nuclear translocation of nucleotide excision repair factors among spiral ganglion neurons. Hear Res 2008; 239:79-91. [PMID: 18329831 DOI: 10.1016/j.heares.2008.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 01/07/2008] [Accepted: 01/31/2008] [Indexed: 10/22/2022]
Abstract
Genomic DNA is a high-affinity target for the antineoplastic molecule cisplatin. Cell survival from cisplatin DNA damage is dependent on removal of cisplatin-DNA adducts by nucleotide excision repair (NER) pathways. The rate-limiting steps in the NER pathways are DNA damage identification and verification. These steps are accomplished by xeroderma pigmentosum complementation group C and A (XPC and XPA) and RNA polymerase II. Unlike RNA polymerase II, XPC and XPA have no known cellular function beyond DNA repair. Cisplatin is known to damage spiral ganglion neurons at the basal coil of the cochlea therefore it was posited that cisplatin may target their DNA and mobilize XPC and XPA. Female Fisher344 rats were given two, four day cycles of cisplatin (2mg/kg) or saline, separated by a 10day rest period. A 2 x 3 x 2 factorial design, consisting of two treatment conditions (cisplatin and saline treatment), three survival times (5, 19 and 22 days) and two analysis methods (quantitative RT-PCR and immunohistochemistry) was employed to evaluate the expression and distribution of XPC and XPA. Quantitative RT-PCR revealed statistically significant differences in cochlear XPC and XPA mRNA levels after cisplatin treatment at all times except day 22 for XPA. Immunohistochemistry revealed that a proportion ( approximately 50%) of spiral ganglion neurons in control rats showed cytoplasmic expression of XPC and XPA. After cisplatin treatment, a similar proportion ( approximately 50%) of spiral ganglion neurons showed increased nuclear expression of XPC and XPA, which appears to represent translocation from the cytoplasm. Basal coil spiral ganglion neurons translocated XPC and XPA at later treatment cycles and with less magnitude than apical coil neurons after cisplatin treatment. Therefore, it is suggested that cisplatin treatment induces nuclear translocation of NER proteins among spiral ganglion neurons and that this nuclear translocation is less efficient at the base relative to the apex.
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Affiliation(s)
- O'neil W Guthrie
- Department of Communication Science and Disorders, University of Pittsburgh, Forbes Tower 4033, Pittsburgh, PA 15260, USA.
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Blebs in inner and outer hair cells: a pathophysiological hypothesis. The Journal of Laryngology & Otology 2008; 122:1151-5. [PMID: 18184450 DOI: 10.1017/s002221510700134x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The ototoxic effects of cisplatin include loss of outer hair cells, degeneration of the stria vascularis and a decrease in the number of spiral ganglion cells. Scanning microscopy has shown balloon-like protrusions (blebs) of the plasma membrane of inner hair cells following cisplatin administration. The present study was undertaken to identify the possible role of inner and outer hair cell blebs in the pathogenesis of cisplatin-induced ototoxicity. MATERIALS AND METHODS Twenty-five guinea pigs were injected with cisplatin and their hearing tested at different time-points, before sacrifice and examination with scanning electron microscopy. RESULTS AND ANALYSIS Seven animals showed blebs in the inner hair cells at different stages. Hearing thresholds were lower in animals showing blebs. DISCUSSION Cisplatin seems to be able to induce changes in inner hair cells as well as in other structures in the organ of Corti. Blebbing observed in animals following cisplatin administration could play a specific role in the regulation of intracellular pressure.
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Asenov DR, Kaga K, Tsuzuku T. Changes in the audiograms of a nasopharyngeal cancer patient during the course of treatment: a temporal bone histopathological study. Acta Otolaryngol 2007; 127:1105-10. [PMID: 17851900 DOI: 10.1080/00016480601127026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This report shows the changes that occurred in consecutive audiograms of a patient who underwent chemotherapy and radiotherapy for nasopharyngeal cancer and the histopathological examination of the temporal bones. Both conductive and sensorineural hearing loss developed, but followed different modes of progression. In the left ear, an air-bone gap appeared and deepened, while in the right ear, severe conductive hearing loss was present upon admission and improved after treatment. Sensorineural hearing loss was worse in the right ear, but deteriorated gradually in both ears. Histology revealed tumor invasion in the right temporal bone. Both middle ears showed effusion, but no radiation-induced changes that may be responsible for the conductive loss. The main changes in the cochlea were vascular stria degeneration, spiral ligament atrophy, and spiral ganglion cell depletion, while the hair cells were only occasionally missing. Apart from confirming what has been established previously by other authors, some interesting findings were observed: (1) in addition to the high frequency hearing loss typically caused by cis-platinum and by radiation, there was also low frequency hearing loss, and (2) the cochlear damage was most severe in the vascular stria and spiral ganglions, sparing the hair cells.
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Affiliation(s)
- Deyan Rosenov Asenov
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, University of Tokyo, Japan.
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Bhandare N, Antonelli PJ, Morris CG, Malayapa RS, Mendenhall WM. Ototoxicity after radiotherapy for head and neck tumors. Int J Radiat Oncol Biol Phys 2007; 67:469-79. [PMID: 17236969 DOI: 10.1016/j.ijrobp.2006.09.017] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Revised: 09/07/2006] [Accepted: 09/08/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the incidence of radiation-induced ototoxicity according to the total dose delivered to specific parts of the auditory system, fractionation, and chemotherapy. METHODS AND MATERIALS Records of 325 patients treated for primary extracranial head and neck tumors with curative intent who received radiotherapy between 1964 and 2000 (median follow-up, 5.4 years) were retrospectively reviewed. Reconstructions of the treatment plans were generated to estimate the doses received by components of the auditory system. RESULTS Radiotherapy-induced morbidity developed in 41.8% of patients (external ear, 33.2%; middle ear, 28.6%; and inner ear, 26.8%). Univariate/multivariate analyses indicate that total dose received by parts of the auditory system seem to be significant, though fractionation and chemoradiation may contribute to the incidence of ototoxicities. Sensorineural hearing loss (SNHL) was observed in 49 patients (15.1%). Univariate and multivariate analyses indicated that age (p = 0.0177 and p = 0.005) and dose to cochlea (p < 0.0001 and p < 0.0001) were significant, and chemoradiation (p = 0.0281 and p = 0.006) may increase the incidence of SNHL. Five-year and 10-year actuarial risk of clinically overt SNHL increased to 37% (p > 0.0001) above doses of 60.5 Gy compared to 3% at doses below 60.5 Gy. For patients treated with adjuvant chemotherapy, clinically overt SNHL increased to 30% compared to 18% in the no-chemotherapy group at 10 years (p = 0.0281). CONCLUSION Radiotherapy toxicity was observed in all parts of the auditory system with median doses for incidence varying between 60 Gy to 66 Gy. Total dose to organ seems to be a significant factor though fractionation and chemo-radiation may contribute to ototoxicities.
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Affiliation(s)
- Niranjan Bhandare
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
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Herrmann F, Dörr W, Müller R, Herrmann T. A prospective study on radiation-induced changes in hearing function. Int J Radiat Oncol Biol Phys 2006; 65:1338-44. [PMID: 16863923 DOI: 10.1016/j.ijrobp.2006.03.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 03/28/2006] [Accepted: 03/28/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE To quantitate changes in hearing function after radiotherapy for head-and-neck tumors. METHODS AND MATERIALS At the Department of Radiotherapy and Radiation Oncology, 32 patients were irradiated for head-and-neck tumors. Three-dimensional treatment planning was applied. Total tumor doses were 30.0-77.6 Gy, local doses to the inner ear (n = 64) ranged from 1.7 to 64.3 Gy. Audiometry was performed before the onset of radiotherapy (RT), at a tumor dose of 40 Gy or at the end of palliative treatment, at the end of curative RT, and 2-6 months post-RT. Assays applied were frequency-specific threshold measurements for air and bone conduction, measurements according to Weber and Rinne, tympanometry and assessment of the stapedius reflex. RESULTS Age and prior disease significantly decreased, whereas previous or concurrent alcohol consumption significantly increased hearing ability. A significant reduction in hearing ability during RT was found for high frequencies (at 40 Gy) and low frequencies (at end of RT), which persisted after RT. No differences were observed for air or bone conduction. None of the other assays displayed time- or dose-dependent changes. Dose-effect analyses revealed an ED50 (dose at which a 50% incidence is expected) for significant changes in hearing thresholds (15 dB) in the range of 20-25 Gy, with large confidence limits. CONCLUSIONS Radiation effects on hearing ability were confined to threshold audiogram values, which started during the treatment without reversibility during 6 months postradiotherapy.
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Affiliation(s)
- Franziska Herrmann
- Department of Oto-Rhino-Laryngology, University of Technology-Dresden, Dresden, Germany
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Marshall NE, Ballman KV, Michalak JC, Schomberg PJ, Burton GV, Sandler HM, Cascino TL, Jaeckle KA, Buckner JC. Ototoxicity of cisplatin plus standard radiation therapy vs. accelerated radiation therapy in glioblastoma patients. J Neurooncol 2005; 77:315-20. [PMID: 16273313 DOI: 10.1007/s11060-005-9049-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the effect of cisplatin (CDDP) plus concurrent radiation therapy on hearing loss. METHODS 451 patients with glioblastoma multiforme (GBM) were randomly assigned after surgery to: Arm A: Carmustine (BCNU) + standard radiation therapy (SRT); Arm B: BCNU + accelerated radiation therapy (ART: 160 cGy twice daily for 15 days); Arm C: CDDP + BCNU + SRT; or Arm D: CDDP + BCNU + ART. Patients on arms C and D received audiograms at baseline, and prior to the start of RT, and prior to cycles 3 and 6. Otologic toxicities were recorded at each visit. RESULTS 56% of patients had hearing loss at baseline. 13% and 50% of patients experienced worsening ototoxicity after 1 year of treatment in arms A and B vs. C and D, respectively, with 13% of those on arms C and D experiencing significant ototoxicity (>or= grade 3) at 6 months. Increasing age was associated with an increased risk of ototoxicity. CONCLUSIONS Increased exposure to CDDP increases the risk of ototoxicity over time. Older patients are more susceptible to hearing loss with CDDP. The low proportion of patients with clinically significant ototoxicity suggests that baseline screening is unnecessary in GBM patients.
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Cheng PW, Liu SH, Hsu CJ, Lin-Shiau SY. Correlation of increased activities of Na+, K+-ATPase and Ca2+-ATPase with the reversal of cisplatin ototoxicity induced by d-methionine in guinea pigs. Hear Res 2005; 205:102-9. [PMID: 15953519 DOI: 10.1016/j.heares.2005.03.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2005] [Accepted: 03/08/2005] [Indexed: 11/23/2022]
Abstract
Na(+), K(+)-ATPase and Ca(2+)-ATPase in the cochlear lateral wall play an important role in maintaining ionic homeostasis and physiologic function of the cochlea. The present study was designed to test whether the changes of Na(+), K(+)-ATPase and Ca(2+)-ATPase activities of the cochlear lateral wall and the brainstem of guinea pigs after receiving cisplatin for seven consecutive days were correlated with the altered auditory brainstem responses (ABR). Furthermore, whether a chemoprotective agent, D-methionine reversed the increased ABR threshold induced by cisplatin accompanied with the increased ATPase activities was also evaluated. The results obtained showed that cisplatin exposure caused not only a significant increase of threshold but also altered various absolute wave and interwave latencies of ABR. In addition, cisplatin significantly decreased the Na(+), K(+)-ATPase and Ca(2+)-ATPase activities in the cochlear lateral wall with a good dose-response relationship. Regression analysis indicated that an increase of ABR threshold was well correlated with a decrease of both Na(+), K(+)-ATPase and Ca(2+)-ATPase activities in the cochlear lateral wall. A chemoprotectant, D-methionine indeed reversed both abnormalities of ABR and ATPase activities in a well correlation function. The selectivity of these observed changes induced by cisplatin and D-methionine was revealed by the findings that cisplatin-treated guinea pigs had normal III-V interwave latency of ABR and no reduction of Na(+), K(+)-ATPase and Ca(2+)-ATPase specific activities in the brainstem, which is in accordance with the nonpenetrable cisplatin across the blood brain barrier. Taken all together, the present findings suggest that biochemical damage and ionic disturbance may contribute to cisplatin-induced ototoxicity to some extent, which can be reversed by d-methionine.
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Affiliation(s)
- Po-Wen Cheng
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Nussenbaum B, Rutherford RB, Krebsbach PH. Bone Regeneration in Cranial Defects Previously Treated with Radiation. Laryngoscope 2005; 115:1170-7. [PMID: 15995502 DOI: 10.1097/01.mlg.0000166513.74247.cc] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS Bone reconstruction in the head and neck region is frequently performed in the context of previous radiation treatment. Thus, the effectiveness of tissue engineering approaches for regenerating bone in radiated defects needs to be determined before considering application to patients. Incomplete healing is described when using osteoinductive protein therapy alone for bone defects previously treated with radiation. We hypothesized that a different approach using ex vivo gene therapy can heal these severely compromised defects. STUDY DESIGN Animal study using Fisher rats. METHODS Two weeks before surgery, rats received either no radiation or a 12 Gray radiation dose to the calvarium. Syngeneic dermal fibroblasts were transduced ex vivo using an adenoviral vector containing the cDNA for bone morphogenetic protein (BMP)-7. Critical-sized calvarial defects were created, and either a transduced cell-seeded scaffold or an autologous bone graft was placed into the defect. Nonradiated defects were harvested 4 weeks later for both groups. Radiated defects treated with bone grafts were harvested at 4 weeks, and those treated with gene therapy were harvested either at 4 or 8 weeks. Gross inspection and histology were used to evaluate wound healing. RESULTS None of the bone grafts had gross or histologic evidence of healing at the wound margins. The nonradiated gene therapy treated defects revealed gross and histologic near-100% bone regeneration by 4 weeks after surgery. By gross inspection, the radiated defects had soft tissue admixed with islands of bone at both 4 and 8 weeks. The histologic appearance revealed areas of dense bone in a nonconfluent pattern admixed with adjacent cells having the morphologic appearance of hypertrophic chondrocytes, suggesting continued endochondral ossification. CONCLUSIONS Preoperative radiation significantly impairs the ability of BMP-7 ex vivo gene therapy to heal rat critical-sized cranial defects. This finding has significant implications for translating this tissue engineering approach to patients with cancer-related segmental bone defects.
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Affiliation(s)
- Brian Nussenbaum
- Department of Otolaryngology--Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Karlidağ T, Kaygusuz I, Keleş E, Yalçin S, Serhatlioğlu SS, Açik Y, Oztürk L. Hearing in workers exposed to low-dose radiation for a long period. Hear Res 2004; 194:60-4. [PMID: 15276676 DOI: 10.1016/j.heares.2004.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2003] [Accepted: 04/19/2004] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to evaluate changes in hearing thresholds with standard and high frequency audiometry in workers exposed to low-dose ionizing radiation for a long period. A total of 57 (49 male and 8 female) technical staff working in radiology-related jobs who were exposed to occupational radiation were included in the study. The control group consisted of 32 (27 male and 5 female) volunteer subjects with normal hearing. The symptoms like tinnitus, vertigo, weakness and lack of appetite were evaluated. A standard ascending/descending method was applied to the subjects of the study and the control groups in order to determine their hearing thresholds at eleven different frequencies between 250 and 16,000 Hz. In the study group, the working duration of subjects ranged from 4 to 23 years, and the percentage of tinnitus, weakness, vertigo and lack of appetite were 47%, 28%, 24% and 17%, respectively. It was observed that pure tone hearing thresholds were markedly increased for 4,000, 6,000, 8,000, 14,000 and 16,000 Hz frequencies in the study group compared to the control group (p<0.01). Levels of static compliance and middle ear pressures of the study group were similar to the control group. Tinnitus, vertigo and hearing loss in high frequencies were observed in the subjects exposed to the radiation for a long period. Subjects under high risk should be evaluated periodically. We suggest that the use of standard and high frequency audiometry together could be beneficial in the evaluation of these subjects.
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Affiliation(s)
- Turgut Karlidağ
- Department of Otorhinolaryngology, Medical Faculty, Firat University, 23119 Elazig, Turkey.
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Abstract
Despite their particular functional consequences, radiotherapy-induced ear injuries remain under-evaluated and under-reported. These reactions may have acute or late character, may affect all structures of the hearing organ, and result in conductive, sensorineural or mixed hearing loss. Up to 40% of patients have acute middle ear side effects during radical irradiation including acoustic structures and about one-third of patients develop late sensorineural hearing loss (SNHL). Total radiotherapy dose and tumour site seem to be among the most important factors associated with the risk of hearing impairment. Thus, reduction in radiation dose to the auditory structures should be attempted whenever possible. New radiotherapy techniques (3-dimensional conformal irradiation, intensity modulated radiotherapy, proton therapy) allow better dose distribution with lower dose to the non-target organs. Treatment of acute and late external otitis is mainly conservative and includes the anti-inflammatory agents (applied topically and systematically). Post-radiation chronic otitis media and the eustachian tube pathology may be managed with tympanic membrane incision with insertion of a tympanostomy tube (grommet), although the benefit of such approach is controversial and some authors advocate a more conservative approach. In these patients the functional deficit can be alleviated by application of bone conduction hearing aids such as, e.g., the bone anchored hearing aid (BAHA). There is no standard therapy for post-irradiation sudden or progressive SNHL yet corticosteroid therapy, rheologic medications, hyperbaric oxygen or carbogen therapy are usually employed (as for idiopathic SNHL), although controversial data on the efficacy of these treatment modalities have been published. In selected cases with bilateral profound hearing loss or total deafness, cochlear implants may prove effective. Further improvements in radiotherapy techniques and progress in otologic diagnostics and therapy may allow better prevention and management of radiation-related acoustic injury.
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Affiliation(s)
- Barbara A Jereczek-Fossa
- Division of Radiation Oncology of the European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
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Wu CC, Young YH, Ko JY. Effect of irradiation on vestibular evoked myogenic potentials in nasopharyngeal carcinoma survivors. Head Neck 2003; 25:482-7. [PMID: 12784240 DOI: 10.1002/hed.10215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study aims to investigate the effect of irradiation on vestibular evoked myogenic potentials (VEMPs) in nasopharyngeal carcinoma (NPC) survivors, because radiotherapy to NPC covers a column from the basal skull to the clavicle level. METHODS Twenty-two irradiated NPC survivors and five fresh NPC patients were subjected to VEMP testing, which is evoked by short-tone burst (95 dBHL, 500 Hz) stimulation. Interactions among VEMPs and radiation effects, such as radiation dosage, postirradiation interval, radiation-induced otitis media, sensorineural hearing loss, or canal paresis, were then explored. RESULTS The mean latencies of p13 and n23 in irradiated ears were significantly delayed compared with either pr-irradiated ears or normal control ears. Delayed VEMPs represented 50% in ears with a mean radiation dosage of 71 Gy, whereas it represented 100% in those with a mean radiation dosage of 123 Gy. Ears with radiation otitis media revealed higher occurrence (65%) of delayed VEMPs than those without radiation otitis media (29%, p <.05), possibly because of radiation sequela affecting the brainstem and neck. However, delayed VEMPs were unrelated to sensorineural hearing loss or canal paresis caused by irradiation. CONCLUSIONS Delayed VEMPs in NPC survivors are possibly due to radiation-induced otitis media, a brainstem lesion, or neck fibrosis. Hence, VEMP testing may expand the test battery for clinicians to explore balance problems in NPC survivors after irradiation.
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Affiliation(s)
- Chen-Chi Wu
- Department of Otolaryngology, National Taiwan University Hospital, 1 Chang-te St, Taipei, Taiwan
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