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Ototoxicity in Children Receiving Platinum Chemotherapy: Underestimating a Commonly Occurring Toxicity That May Influence Academic and Social Development

From the Departments of Neurology, Neurosurgery, and Pediatric Audiology; Medical Informatics and Clinical Epidemiology; Public Health and Preventive Medicine, Oregon Health and Science University; Department of Pharmacy Practice, Oregon State University; and Veterans Administration Medical Center, Portland, OR

Address reprint requests to Edward A. Neuwelt, MD, Blood-Brain Barrier and Neuro-oncology Program, L603 Oregon Health and Science University, Portland, Oregon, 97201; e-mail: neuwelte{at}ohsu.edu

PURPOSE: To describe the frequency and severity of ototoxicity in a series of pediatric patients treated with platinum-based chemotherapy.

PATIENTS AND METHODS: Serial audiologic evaluations were conducted for 67 patients aged 8 months to 23 years who received platinum-based chemotherapy. Audiologic data was analyzed to determine time to hearing-loss using American Speech-Language-Hearing Association (ASHA) criteria, and the effects of treatment and patient characteristics on the incidence and severity of ototoxicity.

RESULTS: Bilateral decreases in hearing were seen in 61% of patients (median time to hearing loss, 135 days). Children treated for medulloblastoma, osteosarcoma, and neuroblastoma had greater incidence and severity of hearing loss. Agreement between the usually reported National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and ASHA criteria was inadequate.

CONCLUSION: Traditional reporting of toxicity data (CTCAE) has under-reported ototoxicity and minimized the significance of hearing loss in children. As pediatric patients experience improved survival, the effects and implications of high-frequency hearing loss with regard to academic achievement and speech and language development are important considerations, especially in patients younger than 5 years.

Supported by a Veteran's Administration Merit Review Grant and by NIH Grants No. NS33618, NS34608, and NS44687 from the National Institute of Neurological Disorders and Stroke (to E.A.N.).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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