Hearing loss in survivors of childhood head and neck rhabdomyosarcoma; a long-term follow-up study

Reineke A. Schoot, Eleonoor A.R. Theunissen, Olga Slater3, Marta Lopez-Yurda, Charlotte L. Zuur, Mark N. Gaze, Yen-Ch'ing Chang, Henry C. Mandeville, Jennifer E. Gains, Kaukab Rajput, Bradley R. Pieters, Raquel Davila Fajardo, Rishi Talwar, Huib N. Caron, Alfons J.M. Balm, Wouter A. Dreschler andJohannes H.M. Merks

Clinical Otolaryngology See Original Here

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Abstract
Objectives
To determine the hearing status of survivors treated for head and neck rhabdomyosarcoma (HNRMS) at long-term follow-up.

Design
Cross-sectional long-term follow-up study.

Setting
Tertiary comprehensive cancer center.

Participants
Survivors treated for head and neck rhabdomyosarcoma during childhood in two concurrent cohorts; survivors in London had been treated with external beam radiotherapy (EBRT-based local therapy); survivors in Amsterdam were treated with AMORE (Ablative surgery, MOld technique afterloading brachytherapy and surgical REconstruction) if feasible, otherwise EBRT (AMORE-based local therapy).

Main outcome measures
We assessed hearing status of HNRMS survivors at long-term follow-up. Hearing thresholds were obtained by pure tone audiometry.

Methods
We assessed the hearing thresholds, the number of patients with clinically relevant hearing loss, and hearing impairment graded according to the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) and Boston criteria. Furthermore, we compared hearing loss between survivors treated with EBRT-based local therapy (London) and AMORE-based local therapy(Amsterdam).

Results
Seventy-three survivors were included (median follow-up 11 years). We found clinically relevant hearing loss at speech frequencies in 19% of survivors. Multivariable analysis showed that survivors treated with EBRT-based treatment and those with parameningeal tumors had significantly more hearing impairment, compared to survivors treated with AMORE-based treatment and non-parameningeal tumors.

Conclusions
One in five survivors of HNRMS developed clinically relevant hearing loss. AMORE-based treatment resulted in less hearing loss compared to EBRT-based treatment. As hearing loss was highly prevalent and also occurred in survivors with orbital primaries, we recommend systematic audiological follow-up in all HNRMS survivors.

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