The Role of Audiometry prior to High-Dose Cisplatin in Patients with Head and Neck Cancer

Abstract

Objectives: To analyze the role of audiometry in considering change to a less ototoxic treatment in head and neck cancer (HNC) patients. Methods: Consecutive patients prescribed high-dose cisplatin (100 mg/m²) between January 2013 and February 2015 were enrolled. Audiometry was performed at baseline and before cisplatin. Change to a less ototoxic agent or reduced cisplatin dose was considered with audiometric decreases >25 dB. Results: A total of 103 patients were included; the median age of the patients was 59 years (range 18−75). Cisplatin was intended curative (58%), adjuvant (32%), or palliative (10%). Forty-two participants (41%) did not commence high-dose cisplatin because of baseline audiometric alterations. Of 61 patients treated with high-dose cisplatin, 40 (66%) showed marked ototoxicity at the end of treatment. The mean hearing loss between initial and final audiometries showed a hearing loss at 4 and 8 kHz in both ears (p = 0.002). Thirteen patients switched to carboplatin and 15 to a lower dose of cisplatin. The outcome was not significantly altered when cisplatin was replaced with carboplatin or cetuximab. Conclusions: Audiometric alterations are common in HNC with high-dose cisplatin, and switching to a less ototoxic regimen does not adversely affect outcome. Audiometric examination could help to prevent hearing loss in this population.

Insight into the current practice of ototoxicity monitoring during cisplatin therapy

“…Cisplatin is considered one of the most ototoxic pharmacologic agents, typically causing bilateral high frequency sensorineural hearing loss with progression to lower frequencies with continued exposure. The potential for permanent bilateral sensorineural hearing loss and tinnitus can occur both during treatment and up to 136 months after therapy completion [1][2][3][4][5][6][7][8] with an incidence of 20-84% [9,10].…”

Feasibility and efficacy of chemoradiotherapy with concurrent split‑dose cisplatin after induction chemotherapy with docetaxel/cisplatin/5‑fluorouracil for locally advanced head and neck cancer

“…According to randomized phase 3 trials comparing ICT regimens, the standard regimen of ICT is docetaxel plus CDDP and fluorouracil (TPF) (9)(10)(11). Notably, high-dose CDDP-based CRT after TPF-ICT is often associated with nephrotoxicity, neurotoxicity, and ototoxicity, partly because of the cumulative CDDP dosage (12,13). Thus, it has been an unmet need that subsequent CRT regimens after TPF-ICT should be optimized.…”

GSTM1 null and GSTT1 null: predictors of cisplatin-caused acute ototoxicity measured by DPOAEs

“…The reported incidence of cisplatin ototoxicity varies from 9 to 91%, based on the differences in chemotherapeutical regimens, patients population, and the definition of ototoxicity, along with variations and inconsistencies in the assessment and grading of hearing loss [ 5 ]. Preventing ototoxicity is crucial; however currently available methods to avoid ototoxic side effects are limited, even in the case of endangered patients: use of platinum drugs with less ototoxic potential (usually carboplatin) [ 4 ], reduced dose of cisplatin [ 6 ], use of otoprotective drugs [ 7 – 10 ], or advices to avoid concomitant or further noise injuries [ 3 ], etc. Many ongoing clinical trials are addressing this issue suggests that useful preventive treatments will soon be available [ 4 ].…”