Clinical and Genetic Risk Factors for Radiation—Associated Ototoxicity

Cranial radiation therapy (CRT) is associated with ototoxicity, which manifests as hearing loss and tinnitus. This article sought to identify clinical determinants and genetic risk factors for ototoxicity among adult survivors of pediatric cancer treated with CRT.

Analyses were completed on 4,938 patients who survived childhood cancer (diagnosed 1970–1986) and were not treated with cisplatin or carboplatin. Two longitudinal surveys were sent, one questioning the presence of tinnitus (“yes, condition still present”) and one the presence of confirmed hearing loss (“yes, condition still present”). Controls must have responded with “no” to both of these questions. Sex, age, type of cancer and radiation dose were also investigated.

With regard to treatment-related ototoxicity, this Childhood Cancer Survivor Study (CCSS) investigation observed that five- year survivors, compared with a sibling control group, had an excess risk of problems with hearing sounds (2.3 times), hearing loss requiring a hearing aid (4.4 times), and hearing loss in one or both ears not corrected by a hearing aid (5.2 times). In a meta-analysis, the risk of tinnitus was 17.2- fold during therapy and 3.7- fold among pediatric cancer survivors compared with siblings.

A greater probability of experiencing CRT-associated tinnitus and hearing loss was observed in males versus females. More likelihood of having persistent dizziness or vertigo, consuming antidepressants, and experiencing poorer overall health was noted in survivors with tinnitus or hearing loss when compared to controls. The following factors were identified to be associated with CRT-related ototoxicity: gender, various neuro-otological symptoms, increased antidepressant use, and poorer self-reported health.

The authors conclude that health care providers can improve the life-quality management of childhood cancer survivors by informing patients and/or their parents of these risks.

Reference

Trendowski MR, Baedke JL, Sapkota Y, et al. (2021) Clinical and genetic risk factors for radiation-associated ototoxicity: A report from the childhood cancer survivor study and the St. Jude Lifetime Cohort. Cancer 1–12.