The cochlear dose and the age at radiotherapy predict severe hearing loss after passive scattering proton therapy and cisplatin in children with medulloblastoma

Abstract

Abstract Background Hearing loss (HL) is associated with worse neurocognitive outcomes among patients with medulloblastoma. We aimed to identify risk factors associated with severe HL and to evaluate the generalizability of a published HL calculator among patients treated with passive scattering proton therapy (PSPT) and cisplatin. Methods We identified patients aged 3–21 years who were treated at our centers between 2007 and 2022. Audiograms were graded using the International Society of Pediatric Oncology (SIOP) Boston scale. Time to grades 3–4 HL was evaluated using Kaplan–Meier and multivariable Cox models to estimate hazard ratios and 95% confidence intervals (CI). Results Seventy-nine patients were treated with PSPT at a median age of 7.5 years (range: 3.1–21.1). The mean cochlear dose (Dmc) (±SD) was 31.5 ± 8.5 Gy, and the cumulative cisplatin dose was 295 ± 50 mg/m2. Fifty-nine patients (75%) received amifostine. Patients completed a median of 9 audiograms (range: 4–22) with a median audiogram follow-up of 49 months (range: 6–177). Twenty-seven patients (34%) had grades 3–4 HL. In adjusted Cox models, only higher Dmc (HR = 1.12, 95% CI:1.06–1.18) was associated with grades 3–4 HL. The predicted 3-year incidence of grades 3–4 HL was 40.0% (95% CI: 21.3–66.3) and 66.7% (95% CI: 35.4–93.7) for children with Dmc ≥36 Gy and age at radiotherapy ≥7 and <7 years, respectively (P = .042). It was 8.9% (95% CI: 2.3–31.6) and 15.6% (95% CI: 5.3–41.1) for children with Dmc <36 Gy and age at radiotherapy ≥7 and <7 years, respectively (P = .78). Conclusions Children <7 years at radiotherapy with a Dmc ≥36 Gy are at higher risk for HL.