Audiological Monitoring in Children Treated with Platinum Chemotherapy

Abstract

Platinum compounds constitute the standard treatment for solid tumors in pediatric oncology. The purpose of this study is to assess the impact of platinum compounds in the development of ototoxicity in children following chemotherapy. This study included 160 patients treated with cisplatin and carboplatin for malignant solid diseases from 2007 to 2014. Their audiograms were classified according to the Boston SIOP ototoxicity scale. Twenty-five percent of the children treated with platinum compounds developed ototoxicity. The incidence of ototoxicity was correlated with the type of platinum derivative (i.e. cisplatin vs. carboplatin), coadministration of both drugs and concomitant cranial radiotherapy, but not with sex and age. Cumulative dose was correlated only with the cisplatin administration. Nine patients (8.6%) showed further progression of hearing impairment after the end of chemotherapy. The low rate of ototoxicity suggests the pivotal role of auditory monitoring in children treated with platinum compounds in order to be able to identify hearing loss at an early stage and to provide, jointly with pediatric oncologists, strategies to reduce further progression of cochlear toxicity.

Effects of chemotherapy on the auditory system of children with cancer: a systematic literature review

“…Al assessment method had to be adapted to the child's response possibilities; therefore, for some of the studies, objective and/or subjective procedures had to be used 8,12,20,28,30,33,39 .…”

“…The OAE, besides being an objective method, an alternative to behavioral auditory assessment, had its inclusion justified by some authors for its potential in assessing outer hair cells function in patients submitted to chemotherapy, capable of providing early evidences of cochlear damage, even before the occurrence of alterations on auditory thresholds obtained through pure-tone audiometry 22,32,36,39 .…”

“…Some studies also included the brainstem auditory evoked potentials (BAEP) 8,12,20,28,30,33,39 ; however, the usefulness of this procedure was mostly in estimating the psychoacoustic threshold of babies and very small children, who are not able to respond to behavioral assessments. Of the seven studies that used the BAEP 8,12,20,21,28,33,39 , only one described the findings from such assessment 20 .…”

“…Two studies considered as hearing loss auditory thresholds superior to 20 dB HL, without mentioning any other specific criterion 24,25 . Other studies also used 20 dB HL as hearing loss criterion, besides including specific criteria to identify the presence of ototoxicity, such as: Common Terminology Criteria for Adverse Events 26 ; Brock grading system 8,35 ; ASHA's criteria referring to ototoxicity 19,34,37 ; Muenster criteria 38 ; SIOP Boston ototoxicity scale 39 ; and a comparison between diverse criteria (ASHA, Brock, Muenster, POGT, BHL) 4,12,33 . On…”

“…Concerning the drug used in chemotherapy treatment, nine studies (39.13%) assessed the effect of cisplatin alone 12,[20][21][22][23][24][25][26][27] , with doses ranging from 50 to 160 mg/m 2 per cycle (cycles between 1 and 6); five studies (21.74%) assessed carboplatin alone [28][29][30][31][32] , with doses ranging from 322 to 2,210 mg/m 2 per cycle (cycles between 1 and 9); and, nine studies (39.13%) assessed the effects of cisplatin and/or carboplatin 4,8,[33][34][35][36][37][38][39] . Of the studies with cisplatin and/or carboplatin, the majority does not mention the number of cycles and/or the doses of each drug per cycle; the total cumulative dose of cisplatin ranged from 20 to 1,000 mg/m 2 , whereas that of carboplatin ranged from 104 to 15,550 mg/m 2 .…”