Enhanced cis-platinum neurotoxicity in pediatric patients with brain tumors

Eight children were treated with cis-platinum for recurrent brain tumor. Six of these children were fully evaluable. All received cis-platinum (total dose per course 60 to 120 mg/m2; up to three courses) by infusion with mannitol and hydration. All had received one or more courses of cranial irradiation. Five of the six patients had evidence of significant hearing loss after only one cycle of treatment. All six patients demonstrated significant audiometric or symptomatic hearing loss after a total dose of 110-120 mg/m2. In patients further challenged with cis-platinum hearing loss progressed significantly. Two patients developed profound deterioration in neurologic status within 72 h after infusion. These experiences suggest that Ototoxicity is accentuated in patients who have received cranial irradiation. Further treatment may lead to prohibitive hearing loss. Severe neurologic deterioration may occur secondary to drug infusion.