Patients with head and neck cancer may experience chemoradiotherapy-induced hearing loss, but the weighing
of involved variables has been subjective. Identification of patient and treatment characteristics to predict the absolute
posttreatment hearing level is important for effective counseling of patients undergoing chemoradiotherapy.
predict treatment-induced hearing loss among patients with head and neck cancer.
Design, Setting, and Participants
retrospective cohort study was performed at The Netherlands Cancer Institute. One hundred and fifty-six patients with head
and neck cancer treated with concomitant chemoradiotherapy as the primary treatment modality from January 1, 1997, through
December 31, 2011, were enrolled. Follow-up was complete on March 1, 2012, and data were analyzed from April 1, 2011, through
November 5, 2013.
High-dose intravenously administered cisplatin-based concomitant chemoradiotherapy.
Cisplatin, 100 mg/m2, was administered in 3 courses on days 1, 22, and 43 during 7 weeks of radiotherapy (total radiation
dose, 70 Gy in 35 fractions).
Main Outcomes and Measures
Posttreatment bone conduction hearing threshold at pure-tone
average frequencies of 1, 2, and 4 kHz, based on pure-tone audiometry after completion of treatment. Predictors included baseline
hearing levels, radiation dose to the cochlea, and cisplatin dose. A multilevel mixed-effects linear regression model for
predicting whether or not posttreatment hearing was at least 35 dB was established, and cross-validated sensitivity and specificity
Of 156 patients who received high-dose concomitant chemoradiotherapy, 15 were missing
the exact radiation dose to the cochlea and 41 had no data on posttreatment pure-tone audiometry. Nineteen patients had a
hearing level of at least 35 dB for at least 1 ear before the treatment. The remaining 81 patients (162 ears) had a total
cumulative cisplatin dose ranging from 315 to 600 (median, 546) mg. The radiation dose to the cochlea ranged from 1.1 to 70.9
(median, 13.6) Gy. Based on data from the 81 patients (162 ears), the area under the receiver operating characteristic curve
was 0.68, with a sensitivity of 29% (95% CI, 13%-51%) and a specificity of 97% (95% CI, 88%-100%), resulting in a positive
predictive value of 78%.
Conclusions and Relevance
Patient and treatment characteristics can be used to predict
hearing level after concomitant chemoradiotherapy for head and neck cancer. This step may constitute the first in evidence-based
individual counseling for treatment-induced hearing loss.