Recording strategy for ENT-specific adverse effects of Proton therapy in childhood for head and neck tumors: an interdisciplinary task.

Introduction  Proton therapy has an important part in treatment of childhood head and neck cancer. Due to the proximity of sensitive ENT organs, side effects should be precisely recorded. The aim of this study was to analyse the recording of ENT-specific side effects and to develop a strategy for optimization.

Methodology Age and tumor entities of children (>/= 3-18 years) with tumors in the head and neck or skull base area who received proton therapy between 2013 and 2022 in the Clinic for Particle Therapy at University Hospital Essen were evaluated. The recording of side effects in the ENT area after proton therapy, therapy results and contouring of organs at risk were analysed.

Results 807 patients were included. 63% had a CNS tumor, 30% a sarcoma, 3% an ENT tumor, 3% an eye tumor and 2% another tumor disease. Adverse effects were recorded according to Common Terminology Criteria for Adverse Events (CTCAE). ENT and skull base specific CTCAEs were hearing, dry mouth, dysphagia, oral mucositis, anosmia, and cranial nerve palsy. For example, hearing loss in pediatric patients was detected by an audiogram considering hearing loss at 4kHz. During therapy acute side effects were recorded weekly. The follow-up included data from clinical examinations, questionnaires or physician’s letters.

Conclusion  Regarding the ENT perspective, audiological side effects should be recorded more precisely. They are important for infratentorial CNS tumors, sarcomas and other tumors of the skull base. In children, objective hearing tests, e.g. measuring otoacoustic emissions, could be important. Therefore, standards should be developed and a prospective interdisciplinary data collection should be connected.

Publication History

Article published online:
12 May 2023