Abstract | OBJECTIVES: The purpose of this study was to evaluate the severity of hearing loss after cisplatin and/or carboplatin treatment in young children and to analyze its evolution and its relation to different therapy schedules. METHODS: One hundred twenty patients treated in the Pediatrics Department at the Institut Gustave-Roussy from 1987 to 1997 for neuroblastoma, osteosarcoma, hepatoblastoma, or germ cell tumors were analyzed. Median age at diagnosis was 2.6 (range 0-17) years. Median follow-up was 7 (1-13) years. Chemotherapy regimens contained cisplatin and/or carboplatin. Three patients also received high-dose carboplatin. Cisplatin was administered at a dose of 200 mg/m/course in 72% of cases. The median cumulative dose was 400 mg/m for cisplatin and 1,600 mg/m for carboplatin. Hearing loss of grade 2 or above, according to Brock's grading scale, was revealed with pure tone audiometry and behavioral techniques. RESULTS:
Carboplatin alone was not ototoxic. Deterioration of hearing of grade 2 or above was observed in 37% of patients treated with cisplatin and 43% of patients treated with cisplatin plus carboplatin (P = NS). Fifteen percent of patients experienced grade 3 or 4 ototoxicity. Ototoxicity was most often observed after a total cisplatin dose of at least 400 mg/m. No improvement was observed with time; on the contrary, worsening or progression of hearing loss at lower frequencies was detected during follow-up. Only 5% of audiograms showed toxicity of at least grade 2 before the end of therapy; in contrast, this level was observed in 11% of early post- therapy evaluations and in 44% after more than 2 years of follow-up. CONCLUSIONS: Children treated with cisplatin at cumulative doses approaching 400 mg/m require long-term surveillance to avoid overlooking hearing deficits. Carboplatin, at a standard dose, does not appear to be a significant risk factor for ototoxicity even in patients who have already been treated with cisplatin.
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Authors | Patrizia Bertolini, Mathilde Lassalle, Guilaine Mercier, Marie Anne Raquin, Giancarlo Izzi, Nadege Corradini, Olivier Hartmann |
Journal | Journal of pediatric hematology/oncology
(J Pediatr Hematol Oncol)
Vol. 26
Issue 10
Pg. 649-55
(Oct 2004)
ISSN: 1077-4114 [Print] United States |
PMID | 15454836
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
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Topics |
- Adolescent
- Age Factors
- Antineoplastic Combined Chemotherapy Protocols
(adverse effects, therapeutic use)
- Audiometry
- Carboplatin
(administration & dosage, adverse effects)
- Child
- Child, Preschool
- Cisplatin
(administration & dosage, adverse effects)
- Disease Progression
- Dose-Response Relationship, Drug
- Female
- Follow-Up Studies
- Hair Cells, Auditory, Outer
(drug effects)
- Hearing Loss, Sensorineural
(chemically induced, epidemiology)
- Humans
- Infant
- Male
- Neoplasms
(complications, drug therapy)
- Oxidative Stress
- Retrospective Studies
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