Ototoxicity evaluation in medulloblastoma patients treated with involved field boost using intensity-modulated radiation therapy (IMRT): a retrospective review

Background: Ototoxicity is a known side effect of combined radiation therapy and cisplatin chemotherapy for the treatment of medulloblastoma. the delivery of an involved field boost by intensity modulated radiation therapy (IMRT) may reduce the dose to the inner ear when compared with conventional radiotherapy. the dose of cisplatin may also affect the risk of ototoxicity. A retrospective study was performed to evaluate the impact of involved field boost using IMRT and cisplatin dose on the rate of ototoxicity.Methods: Data from 41 medulloblastoma patients treated with IMRT were collected. Overall and disease-free survival rates were calculated by Kaplan-Meier method Hearing function was graded according to toxicity criteria of Pediatric Oncology Group (POG). Doses to inner ear and total cisplatin dose were correlated with hearing function by univariate and multivariate data analysis.Results: After a mean follow-up of 44 months (range: 14 to 72 months), 37 patients remained alive, with two recurrences, both in spine with CSF involvement, resulting in a disease free-survival and overall survival of 85.2% and 90.2%, respectively. Seven patients (17%) experienced POG Grade 3 or 4 toxicity. Cisplatin dose was a significant factor for hearing loss in univariate analysis (p < 0.03). in multivariate analysis, median dose to inner ear was significantly associated with hearing loss (p < 0.01). POG grade 3 and 4 toxicity were uncommon with median doses to the inner ear bellow 42 Gy (p < 0.05) and total cisplatin dose of less than 375 mg/m(2) (p < 0.01).Conclusions: IMRT leads to a low rate of severe ototoxicity. Median radiation dose to auditory apparatus should be kept below 42 Gy. Cisplatin doses should not exceed 375 mg/m(2).

Sleep-disordered breathing and orthodontic variables in children-Pilot study

Introduction: Sleep Disordered Breathing (SDB) is a highly prevalent condition associated with orofacial and dentofacial characteristics.Objective: the aim of this study was to verify the association of dental malocclusion, molar relationship, crossbite, open bite, overjet, overbite, and crowding with SDB in children aged 7-9 years.Materials and methods: Participating schools were selected randomly from within the public elementary school system. in the first phase of the study, the parents of 1216 children aged between 7 and 9 years old completed the Sleep Disturbance Scale for Children (SDSC) questionnaire and the children had to participate in a dental examination. the evaluation of occlusion was divided into sagittal analysis, vertical analysis, and transverse analysis. in the second phase, 60 children were selected randomly to be undergone polysomnography (PSG) at a sleep clinic.Results: Among the children included, 242 (19.9%) children had normal occlusion. of the 60 children, 50 underwent PSG and 40(80%) had SDB. the crossbite and open bite showed association with SDB, p = 0.04 in both.Conclusion: Crossbite and open bite malocclusions were associated with SDB, and may be predictive of SDB in children. Studies with larger numbers of participants are needed to investigate the association of other malocclusions with SDB, and randomized clinical trials are also needed to see whether orthodontic and/or functional jaw orthopedic treatment is an option for treating children with malocclusion and SDB. (C) 2014 Elsevier Ireland Ltd. All rights reserved.