Pretreatment test predicts ototoxic effects in head and neck cancer


By David Douglas

NEW YORK (Reuters Health) - A prediction model can help indicate the extent of potential hearing loss before patients with head and neck cancer undergo radiotherapy and cisplatin chemotherapy, researchers say.

Dr. Andrew Schuette told Reuters Health by email, "I remember my parents' vulnerability during their cancer treatments because they didn't know what to expect. Our patients at risk of hearing loss from cancer treatment experience the same."

"To ease their burden," he added, "we built the first predictive model of hearing loss that can be used before treatment to let patients know what to expect."

Dr. Schuette of Barnes-Jewish Hospital, in St. Louis, Missouri, and colleagues examined data on 242 patients with head and neck cancer. All had had audiologic evaluation about a month before and two months after treatment with radiotherapy and/or cisplatin.

The researchers note that they "sought to replicate and enhance prior models of ototoxic effects by building a standard model of ototoxic effects that relied on information that was available only after the patient had fully completed treatment."

The team then used those results as a benchmark to assess the performance of the new predictive model "that uses only information available to clinicians at the beginning of treatment."

They compared patient hearing level, as measured by the mean of pure tone audiometry at 1, 2, and 4 kHz on completion of treatment with that achieved using the prediction model.

The fixed-effects predictions agreed with 77% of the variability in the post-treatment pure-tone average. The model had a sensitivity of 80% and a specificity of 75% for predicting an observed post-treatment pure-tone average greater than 35 dB.

The results confirm that "age, baseline pure tone averages, cisplatin dose, and mean cochlear radiotherapy dose are associated with post-treatment hearing," the researchers write.

Dr. Schuette noted, "We are testing our model now on a different patient population before recommending broad clinical adoption."

The study had no commercial funding.


JAMA Otolaryngol Head Neck Surg 2019.

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