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Radiotherapy enhanced ototoxicity of cisplatin in children
S Miettinen1, E Laurikainen, R Johansson
1Department of Otolaryngology, Turku University Central Hospital, Finland.
Insights
Children treated with both radiotherapy and cisplatin for intracranial tumors experienced significant high-frequency hearing loss. This combined therapy approach warrants cautious consideration in pediatric cancer treatment.
Area of Science:
- Pediatric Oncology
- Ototoxicity Research
- Neuro-oncology
Background:
- Cancer treatment in children can lead to long-term side effects.
- Ototoxicity is a known complication of certain cancer therapies.
- Understanding the specific risks associated with combined treatments is crucial.
Purpose of the Study:
- To evaluate hearing thresholds in children treated for neoplasms.
- To investigate the impact of different cancer treatment modalities on hearing.
- To identify factors contributing to hearing loss in pediatric cancer patients.
Main Methods:
- Retrospective review of 31 children (6 months-14 years) treated between 1989-1994.
- Classification into three groups based on tumor site and therapy: Group I (intracranial tumor, radio- and cisplatin chemotherapy), Group II (intracranial tumor, radiotherapy only), Group III (extracranial malignancy, cisplatin chemotherapy).
- Audiometric assessment to determine hearing thresholds, particularly in middle and high frequencies.
Main Results:
- Children in Group I (radiotherapy + cisplatin) exhibited significantly worse hearing thresholds in the middle- and high-frequency ranges compared to Groups II and III.
- No correlation was found between individual cisplatin dose, inner ear irradiation dose, or total central nervous system (CNS) irradiation dose and hearing loss.
- Multiple linear correlation analyses indicated a combined effect of radiotherapy and cisplatin in causing high-frequency hearing loss.
Conclusions:
- The combination of radiotherapy and cisplatin chemotherapy in children with intracranial malignancies is associated with significant high-frequency hearing loss.
- Individual treatment components (cisplatin dose, irradiation dose) did not correlate directly, suggesting a synergistic effect.
- Radiotherapy should be used cautiously in children receiving cisplatin for intracranial tumors due to the risk of ototoxicity.
Abstract:
We reviewed and re-examined 31 children (6 months-14 years at the time of diagnosis), who had been treated for a neoplasm in Turku University Central Hospital between 1989 and 1994. The children were divided into 3 groups according to the site of the neoplasm and the type of therapy. Group I included 13 children, operated on for an intracranial tumor and received postoperative radio- and cisplatin-based chemotherapy. Group II included 14 children operated on for intracranial tumors and treated with radiotherapy, but not given chemotherapy. Group III included 4 children suffering from extracranial malignancies and they had received chemotherapy including cisplatin. The children in Group I had significantly worse hearing thresholds in the middle- and high-frequency range than children in Groups II and III. In a precise analysis of the different factors, no single dose of cisplatin, inner ear irradiation dose or totally to the central nervous system (CNS) received irradiation dose correlated to the detected hearing loss. However, multiple linear correlation analyses suggest a combined effect of radiotherapy plus cisplatin resulting in a high frequency hearing loss. This is in accordance with earlier random case reports, and supports the idea that radiotherapy should be considered cautiously in children treated with cisplatin for intracranial malignancies.