BACKGROUND: Intensive, irradiation-sparing chemotherapy regimens for malignant brain tumors have improved survival and neurocognitive outcomes in very young children. Platinum compounds are pivotal to this approach's success but are associated with hearing loss that markedly reduces quality of life for survivors. The purpose of this study was to determine the prevalence and severity of ototoxicity associated with Head Start and similar irradiation-sparing regimens. PROCEDURE: A retrospective cohort study was conducted of children treated for malignant brain tumors at Children's Hospital Los Angeles using irradiation-sparing regimens. Patient and treatment characteristics were ascertained. Primary outcomes were post-treatment hearing status, need for hearing aids, and hearing threshold change. RESULTS: Twenty-nine patients were evaluable. The most common diagnosis was medulloblastoma (n = 14). The median age at diagnosis was 2.0 years (range, 0.2-9.2). Median time from diagnosis to most recent hearing assessment was 1.1 years (mean 2.4; range, 0.2-17.5). Cumulative cisplatin and carboplatin dose was 281 ± 88 mg/m(2) and 1,205 ± 277 mg/m(2) , respectively. All patients had aminoglycoside exposure. Following treatment, 18 patients (62.1%) had abnormal hearing and 11 (37.9%) required hearing aids. At 4,000 Hz, statistically significant hearing loss was documented in the range of 30-40 dB. CONCLUSIONS: While eliminating cranial irradiation has dramatically improved survival and neurocognitive and neuroendocrine outcomes in this population, clinically significant hearing loss is now the leading late effect due to the necessity of platinum-based chemotherapy. Our results document the need for audiometric monitoring and developing otoprotective strategies in this vulnerable population.
BACKGROUND: Intensive, irradiation-sparing chemotherapy regimens for malignant brain tumors have improved survival and neurocognitive outcomes in very young children. Platinum compounds are pivotal to this approach's success but are associated with hearing loss that markedly reduces quality of life for survivors. The purpose of this study was to determine the prevalence and severity of ototoxicity associated with Head Start and similar irradiation-sparing regimens. PROCEDURE: A retrospective cohort study was conducted of children treated for malignant brain tumors at Children's Hospital Los Angeles using irradiation-sparing regimens. Patient and treatment characteristics were ascertained. Primary outcomes were post-treatment hearing status, need for hearing aids, and hearing threshold change. RESULTS: Twenty-nine patients were evaluable. The most common diagnosis was medulloblastoma (n = 14). The median age at diagnosis was 2.0 years (range, 0.2-9.2). Median time from diagnosis to most recent hearing assessment was 1.1 years (mean 2.4; range, 0.2-17.5). Cumulative cisplatin and carboplatin dose was 281 ± 88 mg/m(2) and 1,205 ± 277 mg/m(2) , respectively. All patients had aminoglycoside exposure. Following treatment, 18 patients (62.1%) had abnormal hearing and 11 (37.9%) required hearing aids. At 4,000 Hz, statistically significant hearing loss was documented in the range of 30-40 dB. CONCLUSIONS: While eliminating cranial irradiation has dramatically improved survival and neurocognitive and neuroendocrine outcomes in this population, clinically significant hearing loss is now the leading late effect due to the necessity of platinum-based chemotherapy. Our results document the need for audiometric monitoring and developing otoprotective strategies in this vulnerable population.
Authors: James G Gurney; Johnnie K Bass; Arzu Onar-Thomas; Jie Huang; Murali Chintagumpala; Eric Bouffet; Tim Hassall; Sridharan Gururangan; John A Heath; Stewart Kellie; Richard Cohn; Michael J Fisher; Atmaram Pai Panandiker; Thomas E Merchant; Ashok Srinivasan; Cynthia Wetmore; Ibrahim Qaddoumi; Clinton F Stewart; Gregory T Armstrong; Alberto Broniscer; Amar Gajjar Journal: Neuro Oncol Date: 2014-01-10 Impact factor: 12.300
Authors: Aniket Saha; Christina G Salley; Preeti Saigal; Linda Rolnitzky; Judith Goldberg; Suzanne Scott; Randal Olshefski; Juliette Hukin; Stephen A Sands; Jonathan Finlay; Sharon L Gardner Journal: Pediatr Blood Cancer Date: 2014-05-01 Impact factor: 3.167
Authors: David R Freyer; Lu Chen; Mark D Krailo; Kristin Knight; Doojduen Villaluna; Bonnie Bliss; Brad H Pollock; Jagadeesh Ramdas; Beverly Lange; David Van Hoff; Michele L VanSoelen; John Wiernikowski; Edward A Neuwelt; Lillian Sung Journal: Lancet Oncol Date: 2016-12-01 Impact factor: 41.316