Results of a multicentre randomised controlled trial of cochlear-sparing intensity-modulated radiotherapy versus conventional radiotherapy in patients with parotid cancer (COSTAR; CRUK/08/004).

Nutting, Christopher M and Morden, James P and Beasley, Matthew and Bhide, Shreerang and Cook, Audrey and De Winton, Emma and Emson, Marie and Evans, Mererid and Fresco, Lydia and Gollins, Simon and Gujral, Dorothy and Harrington, Kevin and Joseph, Mano and Lemon, Catherine and Luxon, Linda and van den Blink, Qurrat and Mendes, Ruheena and Miah, Aisha and Newbold, Kate and Prestwich, Robin and Robinson, Martin and Sanghera, Paul and Simpson, Joanna and Sivaramalingam, Muthiah and Srihari, Narayanan Nair and Sydenham, Mark and Wells, Emma and Witts, Stephanie and Hall, Emma (2018) Results of a multicentre randomised controlled trial of cochlear-sparing intensity-modulated radiotherapy versus conventional radiotherapy in patients with parotid cancer (COSTAR; CRUK/08/004). European journal of cancer (Oxford, England : 1990), 103. pp. 249-258. ISSN 1879-0852. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://www.ejcancer.com/article/S0959-8049(18)311...

Abstract

PURPOSE

About 40-60% of patients treated with post-operative radiotherapy for parotid cancer experience ipsilateral sensorineural hearing loss. Intensity-modulated radiotherapy (IMRT) can reduce radiation dose to the cochlea. COSTAR, a phase III trial, investigated the role of cochlear-sparing IMRT (CS-IMRT) in reducing hearing loss.

METHODS

Patients (pT1-4 N0-3 M0) were randomly assigned (1:1) to 3-dimensional conformal radiotherapy (3DCRT) or CS-IMRT by minimisation, balancing for centre and radiation dose of 60Gy or 65Gy in 30 daily fractions. The primary end-point was proportion of patients with sensorineural hearing loss in the ipsilateral cochlea of ≥10 dB bone conduction at 4000 Hz 12 months after radiotherapy compared using Fisher's exact test. Secondary end-points included hearing loss at 6 and 24 months, balance assessment, acute and late toxicity, patient-reported quality of life, time to recurrence and survival.

RESULTS

From Aug 2008 to Feb 2013, 110 patients (54 3DCRT; 56 CS-IMRT) were enrolled from 22 UK centres. Median doses to the ipsilateral cochlea were 3DCRT: 56.2Gy and CS-IMRT: 35.7Gy (p < 0.0001). 67/110 (61%) patients were evaluable for the primary end-point; main reasons for non-evaluability were non-attendance at follow-up or incomplete audiology assessment. At 12 months, 14/36 (39%) 3DCRT and 11/31 (36%) CS-IMRT patients had ≥10 dB loss (p = 0.81). No statistically significant differences were observed in hearing loss at 6 or 24 months or in other secondary end-points including patient-reported hearing outcomes.

CONCLUSION

CS-IMRT reduced the radiation dose below the accepted tolerance of the cochlea, but this did not lead to a reduction in the proportion of patients with clinically relevant hearing loss.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: QZ Pathology. Oncology
WN Medical imaging. Radiology
Divisions: Planned IP Care > Oncology and Clinical Haematology
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Depositing User: Miss Emily Johnson
Date Deposited: 24 May 2019 14:55
Last Modified: 24 May 2019 14:55
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/2109

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