Keilty et al reported risk factors for hearing loss in pediatric patients undergoing chemoradiation for a head and neck or brain tumor. These can help to identify a patient who may benefit from a modification in therapeutic regimen. The authors are from Princess Margaret Cancer Centre and Hospital for Sick Children in Toronto.
Patient selection: head and neck cancer or brain tumor
Outcome: Hearing loss, which tends to get worse over time.
Risk factors for hearing loss:
(1) mean radiation dose to the cochlea > 30 Gy
(2) chemotherapy with cisplatin or carboplatin
(3) age at radiation less than 3 years
If the patient is to be treated with either cisplatin or carboplatin, then:
(1) lower the mean radiation dose to the cochlea to under 25 Gy, preferably under 20 Gy
(2) use the lowest dose of the platinum agent
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