Ototoxicity and cochlear sparing in children with medulloblastoma: Proton vs. photon radiotherapy

Publication date: Available online 17 January 2018
Source:Radiotherapy and Oncology
Author(s): Arnold C. Paulino, Anita Mahajan, Rong Ye, David R. Grosshans, M. Fatih Okcu, Jack Su, Mary Frances McAleer, Susan McGovern, Victor A. Mangona, Murali Chintagumpala
PurposeTo compare ototoxicity rates between medulloblastoma patients treated with protons vs. photons.Materials and methodsThe study included 84 children diagnosed with medulloblastoma treated with either passively scattered protons (n = 38) or photons (n = 46). Patients underwent maximal safe resection followed by craniospinal irradiation, posterior fossa and/or tumor bed boost and chemotherapy according to one of 3 multi-institutional trials. Median audiogram follow-up was 56 months for protons and 66 months for photons.ResultsMean cochlear dose (Dmc) was lower in patients treated with protons for both standard (p < 0.0001) and high-risk disease (p < 0.001). Grade 3 and 4 ototoxicity was seen in 7 of 75 (9.3%) and 9 of 91 (9.9%) ears (Brock, p = 0.91), 13 of 75 (17.3%) and 19 of 91 (20.9%) ears (POG, p = 0.56), and 15 of 75 (20.0%) and 21 of 91 (23.1%) ears (SIOP Boston, p = 0.63) with protons and photons respectively.ConclusionsWhile cochlear doses were lower in the proton group, patients treated with either protons or photons had similar Grade 3 and 4 ototoxicity rates.



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