Platinum-Induced Ototoxicity in Children and Adolescents with Cancer

Objective: To evaluate hearing impairment in children with cancer who received platinum compounds. Materials and Methods: There were 149 children who had received platinum-containing chemotherapy (cisplatin, carboplatin or both), and 62 of them v ere eligible in terms of medical and audiologic data. These patients were divided into three groups; cisplatin-only group (30 children), carboplatin-only group (15 children) and cisplatin + carboplatin group (17 children). Results: Sixty-two patients were analyzed. Audiological assessments included pure tone audiometry, transient oto-acoustic emissions and auditory brainstem response testing. Medical records were analyzed for patient characteristics, details of platinum containing treatment, co-administration of other ototoxic drugs as well as head/neck radiotherapy. The median age at treatment was 9.4 years, and M:F ratio was 0.8. Ototoxicity incidence was 56% in cisplatin-only group (n=30), and 47% in cisplatin+carboplatin group (n=17). No patients had ototoxicity in carboplatin-only group (n=15). Majority (84%) of patients having ototoxicity was older than 5 years of age at the initial cancer diagnosis. Of the patients with moderate-severe ototoxicity, 90% was female, and 56% was pubertal/postpubertal girls. Conclusion: The results of this study is in agreement with previous reports showing that ototoxicity is a potential side effect of cisplatin, but the standard dose of carboplatin-only usually does not cause ototoxicity. In this study, children older than 5 years of age and adolescents were also susceptible to develop platinum-induced ototoxicity. Primary tumor site was a risk factor for ototoxicity in this group of patients. Children with germ cell tumors, particularly the intracranial germ cell tumors tended to develop ototoxicity more frequently. Collaboration of pediatric oncology and audiology departments is mandatory in order to monitor platinum induced ototoxicity to avoid further insult and also to rehabilitate when mutilating toxicity occurs.