3440 - Audiologic Surveillance Gaps and Hearing Threshold Shifts Following IMRT for Head and Neck Cancer
Presenter(s)
C. Chang-Chien1, N. T. Jiam2, Y. S. Cheng2, J. C. Hong3, S. S. Yom3, and J. W. Chan1; 1University of California, San Francisco, San Francisco, CA, 2University of California, San Francisco, Department of Otolaryngology - Head and Neck Cancer, San Francisco, CA, 3University of California, San Francisco, Department of Radiation Oncology, San Francisco, CA
Purpose/Objective(s): Platinum-based chemoradiation is associated with ototoxicity in head and neck cancer (HNC) patients. ACS HNC Survivorship guidelines recommend routine hearing surveillance for patients receiving chemoradiation, but real-world patterns remain poorly characterized. We evaluated audiologic testing rates and pure-tone average (PTA) changes in HNC patients following IMRT with or without systemic therapy.
Materials/Methods: We performed a retrospective cohort study of 1,695 HNC patients (ICD-10 C00-C14) treated with IMRT at a tertiary academic center from 2012-2025. PTA data were extracted from institutional health records. Patients were grouped as receiving radiation alone (RT; n=869) or radiation with systemic therapy (RTS; n=826; cisplatin, carboplatin, cetuximab, or combinations), sub-classified as concurrent (RTS-C; n=333) or sequential (RTS-S; n=493). Any testing was defined as =1 audiogram within 12 months before or any time after RT; complete audiologic evaluation required both pre- and post-treatment audiograms. Threshold shifts were evaluated at speech (1, 2, 4 kHz) and high frequencies (4, 6, 8 kHz) via Wilcoxon signed-rank test. A linear mixed-effects model examined post-treatment PTA over time, adjusting for age, sex, laterality, subsite, and systemic agent. Screened and unscreened patients were compared for selection bias.
Results: Any audiologic testing occurred in only 29% (492/1695) of patients; among these, 44% lacked a pre-treatment baseline and 27% had no post-treatment follow-up. Post RT testing occurred in 18.6% (315/1695): 10.9% (185/1695) within 6 months after RT; 2.8% (48/1695) between 7-12 months, and 4.8% (82/1695) beyond 12 months. Complete audiologic evaluation occurred in 10.9% of RTS patients and 2.0% of RT-only patients; rates were similarly low for RTS-C (7.5%) and RTS-S (13.2%) subgroups. After adjustment for treatment intensity and subsite, Black race (aOR 0.47, 95% CI 0.24-0.91), Cantonese-speaking (aOR 0.45, 95% CI 0.24-0.86), and Medicaid insurance (aOR 0.47, 95% CI 0.33-0.68) were less likely to be screened (all p<0.05). Among patients with paired audiograms, 18.4% experienced significant speech-frequency hearing loss (=10 dB, mean +23.6 dB among affected) and 29.6% experienced significant high-frequency loss (mean + 24.4 dB). PTA shifts were greater in RTS-C vs RTS-S patients (+8.7 vs +4.3 dB; p<0.001). Cisplatin was associated with progressive threshold elevation (ß=+0.27 dB/month, ~+3.2 dB/yr, p<0.001).
Conclusion: Fewer than one-third of HNC IMRT patients underwent institutional audiologic testing, and fewer than 7% had completed audiometric evaluation in per ACS guidelines. Threshold shifts were greatest among RTS-C patients, the least consistently screened group. These findings highlight gaps in audiologic surveillance among HNC patients receiving IMRT and underscore the need for standardized, guideline-based protocols, particularly for patients receiving concurrent platinum-based chemoradiation.