Choice of Radiosensitizer in Baseline Grade-2 Sensorineural Hearing Loss (SNHL) in Head and Neck Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Rule of Thumb:
    • Avoid cisplatin in patients with grade ≥ 2 baseline hearing loss 
  • Cisplatin:
    • Is ototoxic and can cause irreversible worsening of SNHL:
      • Risk is cumulative and dose-dependent
  • Alternatives:
    • Cetuximab + Radiotherapy (RT):
      • NCCN-endorsed option for cisplatin-ineligible patients
      • Inferior to cisplatin in HPV-positive disease:
        • RTOG-1016, De-ESCALaTE trials:
          • But appropriate when platinum is contraindicated
  • Carboplatin-based chemoradiation:
    • Some centers use carboplatin (AUC 1 to 2 weekly) ± 5-FU or paclitaxel with RT:
      • Evidence less robust than cisplatin:
        • But can be considered when cetuximab is unsuitable
  • Practice Pearls:
    • Baseline audiogram required in all patients before starting cisplatin or alternatives
    • Avoid concurrent ototoxic drugs:
      • Loop diuretics, aminoglycosides, high-dose salicylates
    • Monitor hearing during therapy if any platinum agent is considered
  • References:
    • NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers, Version 2025.
    • Ahn MJ, D’Cruz A, Vermorken JB, et al. Eligibility criteria for cisplatin in head and neck cancer: consensus recommendations. Lancet Oncol. 2016;17(8):e447–e456.
    • Gillison ML, Trotti AM, Harris J, et al. Radiotherapy plus cetuximab or cisplatin in HPV-positive oropharyngeal cancer (RTOG-1016). Lancet. 2019;393:40–50.
    • Mehanna H, et al. Radiotherapy plus cisplatin or cetuximab in low-risk HPV-positive oropharyngeal cancer (De-ESCALaTE). Lancet. 2019;393:51–60.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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