Carboplatin is a well-established chemotherapeutic agent used to treat a variety of pediatric malignancies. Platinum analogues such as cisplatin are known to be ototoxic, but little is known regarding the ototoxicity of carboplatin. We performed a single institution retrospective chart review of pediatric oncology patients who received platinum-containing regimens from 1993 to 2002. Ninety-nine patients with sufficient medical and audiologic data were identified. Significant hearing loss was defined as a Brock grade 1 or higher. The incidence was compared among 3 treatment groups (carboplatin only, carboplatin and cisplatin, and cisplatin only). Significant hearing loss in patients receiving carboplatin only was rare, observed in only 1/25 (4%) of patients. In contrast, 19/27 (70%) of patients receiving carboplatin and cisplatin possessed significant hearing loss, as did 27/47 (57%) of those patients receiving cisplatin only P<0.001. The difference in hearing loss could not be explained by different cumulative exposures of the platinum agents. Carboplatin, when used without cisplatin, is rarely associated with severe hearing loss, even at high cumulative doses.

No abstract

The treatment of Wilms tumor (WT) is one of the great success stories in the field of oncology. Five-year overall survival (OS) estimates are 90% using modern treatment regimens, including surgery, chemotherapy, and radiotherapy (RT). 1 However, WT survivorship comes at a cost, as meticulously demonstrated by the Childhood Cancer Survivor Study (CCSS) and the National Wilms Tumor Late Effects Study (NWTS). [2][3][4] In the CCSS cohort, the cumulative incidence of chronic health conditions among survivors of WT was 65% at 25 years after WT diagnosis. WT survivors had an incidence of severe (grade 3 and 4, according to the National Cancer Institute Common Terminology Criteria for Adverse Events grading system) chronic health conditions that was 4.7 times that of their sibling comparison group.2 Common chronic health conditions included congestive heart failure, renal failure, and hypertension. Subsequent malignant neoplasms (SMNs) are another well-documented late complication of WT therapy. In the CCSS cohort of 1256 survivors of WT, the cumulative incidence of SMNs was 3.0% at 25 years from the time of WT diagnosis, with the most common being soft tissue sarcoma (6 cases) and breast cancer (5 cases).2 In a previously reported NWTS cohort of 5287 survivors of WT, the cumulative incidence of SMNs was 1.6% at 15 years after WT diagnosis. 5The most common SMNs were carcinomas (13 cases), sarcomas (13 cases), and leukemias (9 cases); 3 cases of breast cancer were observed. In a combined international cohort of 13,351 survivors of WT, a cumulative risk of second solid tumors of 6.7% at age 40 years was observed; 23 survivors in this cohort had breast cancer. 6The article by Lange et al in this issue of Cancer describes what appears to be the largest number of breast cancer cases among survivors of WT reported to date and sheds light on measures that can be taken for both primary and secondary prevention. 7 The study included a total of 2492 female survivors of WT who were enrolled on one of the first 4 NWTS trials . Twenty-nine cases of invasive breast cancer were identified among 28 patients. The median age at the time of first breast cancer diagnosis was 34.3 years (range, 15.5 years-48.4 years) and the median time from WT diagnosis to breast cancer diagnosis was 27.1 years (range, 7.9 years-35.7 years). The estimated cumulative risk of breast cancer at age 40 years (CR40) for all female survivors of WT was 4.5% (95% confidence interval [95% CI], 2.8-7.2), with a standardized incidence ratio (SIR) of 9.1 (95% CI, 6.0-13.0) compared with the general US population. The risk of breast cancer was most pronounced in the cohort of patients who received chest RT, with a CR40 of 14.8% (95% CI, 8.7%-24.5%) and an SIR of 27.4 (95% CI, 16.1-44.2). It is interesting to note that the risk of breast cancer was elevated compared with the general population in patients who received abdominal RT only, with a CR40 of 3.1% (95% CI, 1.3%-7.1%) and an SIR of 6.0 (95% CI, 2.9-11.0). This SIR was not statistically significantly different f...

No abstract

No abstract