Table 15. Auditory Late Effects
||Potential Auditory Effects
|FM = frequency modulated.
|Platinum agents (cisplatin, carboplatin); radiation impacting the ear
||Ototoxicity; sensorineural hearing loss; tinnitus; vertigo; dehydrated ceruminosis; conductive hearing loss
||History: hearing difficulties, tinnitus, vertigo
|Amplification in patients with progressive hearing loss
|Speech and language therapy for children with hearing loss
|Otolaryngology consultation in patients with chronic infection, cerumen impaction, or other anatomical problems exacerbating or contributing to hearing loss
|Educational accommodations (e.g., preferential classroom seating, FM amplification system, etc.)
Orbital and Optic
Orbital complications are common after radiation therapy for retinoblastoma, childhood head and neck sarcomas, and CNS tumors, and as part of total-body irradiation (TBI).
For survivors of retinoblastoma, a small orbital volume may result from either enucleation or radiation therapy. Age younger than 1 year may increase risk, but this is not consistent across studies.[15,16] Progress has been made in the management of retinoblastoma with better enucleation implants, intravenous chemoreduction, and intra-arterial chemotherapy in addition to thermotherapy, cryotherapy, and plaque radiation. Longer follow-up is needed to assess the impact on vision in patients undergoing these treatment modalities.[15,17,18,19] Previously, tumors located near the macula and fovea were associated with an increased risk of complications leading to visual loss, although treatment of these tumors with foveal laser ablation has shown promise in preserving vision.[19,20,21,22,23,24,25] (Refer to the PDQ summary on Retinoblastoma Treatment for more information on the treatment of retinoblastoma.)
Survivors of orbital rhabdomyosarcoma are at risk of dry eye, cataract, orbital hypoplasia, ptosis, retinopathy, keratoconjunctivitis, optic neuropathy, lid epithelioma, and impairment of vision after radiation therapy doses of 30 Gy to 65 Gy. The higher dose ranges (>50 Gy) are associated with lid epitheliomas, keratoconjunctivitis, lacrimal duct atrophy, and severe dry eye. Retinitis and optic neuropathy may also result from doses of 50 Gy to 65 Gy and even at lower total doses if the individual fraction size is greater than 2 Gy. Cataracts are reported after lower doses of 10 Gy to 18 Gy.[27,28,29,30,31,32] (Refer to the PDQ summary on Childhood Rhabdomyosarcoma Treatment for more information on the treatment of rhabdomyosarcoma in children.)