Hearing loss after cisplatin-based chemoradiation: fundamental steps towards preventive strategies

Abstract

Cisplatin-based chemoradiotherapy is the standard treatment for locally advanced head and neck cancer. However, it can cause side effects, including cisplatin-induced hearing loss. This thesis demonstrates that both treatment-related and patient-related factors contribute to the risk of developing hearing loss. A weekly cisplatin regimen was associated with less clinically relevant hearing

loss compared to a triweekly regimen, whereas different hydration schedules did not appear to influence hearing outcomes. In addition, patients with lower skeletal muscle mass were more susceptible to developing hearing loss.

Additionally, the thesis demonstrates that the TUNE ototoxicity grading system more accurately reflects

patient-reported hearing loss than the commonly used CTCAE and ASHA criteria, supporting its implementation in both clinical practice and research. This thesis presented the SOUND trial protocol, a phase III study investigating transtympanic sodium thiosulfate as a potential strategy to prevent cisplatin-induced hearing loss without compromising cisplatin's anticancer efficacy. We observed asymmetrical hearing loss in a few cases following cisplatin-based chemoradiotherapy and described it in a case series. Together, these findings will improve risk assessment and prevention of cisplatin-induced hearing loss in the future.