Early detection of platinum-induced ototoxicity in adults

Problems/objectives: Multiple toxicities, including ototoxicity, have been reported for patients treated with the widely used, anti-solid tumour agent, cisplatin. We now present a concise review of the literature, and the results of a study into incidence rates for ototoxicity in adult patients receiving cisplatin. Methodology: Eighty patients receiving cisplatin-based chemotherapy or chemo-radiotherapy were prospectively enrolled in our monitoring program; head and neck cancer patients also received radiotherapy on the cochlea. Histories, clinical examinations, and audiometric studies were performed before treatment, and then after three cycles of chemotherapy. Hearing was evaluated using different criteria for the diagnosis and grading of ototoxicity. Results: Using the well-known ASHA (American Speech-Language-Hearing Association) criteria, ototoxicity, with and without high frequency audiometry, was identified in 28 (35%), and 40 patients (50%), respectively. Common Terminology Criteria for Adverse Events identified ototoxicity in 19 patients (24%), with 5 (6%), 4 (5%), and 10 (13%), manifesting severe, moderate, or mild hearing impairments, respectively. Fourteen patients (18%) reported being symptomatic, with only 14 demonstrating baseline, bilateral DPOAE. Conclusions: Depending on the diagnostic criteria/grading system used, ototoxicity during cisplatin-based chemotherapy/ chemo-radiotherapy occurred in up to half of our patients, supporting the need for more pro-active patient monitoring. High sensitivity, high frequency audiometry enables diagnoses to be reached before hearing loss becomes clinically relevant. Unfortunately, DPOAE measurements are mostly absent at baseline in older patients, rendering these of limited use in assessing this patient group.