[Cisplatin and carboplatin-induced ototoxicity in children: clinical aspects and perspectives for prevention].
In 70% of the cases of malignant neoplasms in pediatric patients antiblast therapy is used. The administration of platinum compounds, Cisplatin (CDDP) or Carboplatin (CBDCA), often at high cumulative doses, necessarily implies a certain degree of toxicity which normally takes on secondary significance in the healing of the child. Among the side effects, early and delayed ototoxicity is well known and, in the child, take on particular aspects. While not abandoning the treatment of the base pathology, the therapeutic findings, increasingly comforting in terms of long-term survival, require more accurate evaluation and overall control of the quality of life of these young patients. Since initial cochlear damage can be reversible, auditory function must be carefully monitored in order to prevent the lesions from becoming permanent, in particular prior to the onset of speech. For this reason a retrospective study was made of a group of 26 children affected by malignant neoplasms all of whom had undergone a polychemotherapy protocol with the administration of CDDP in 14 cases and CBDCA in 12 cases. All these young patients were monitored with conventional audiometry. The presence of different variables (antiblastic drug administration schedule, course of the disease, general conditions) only permitted evaluation of a single correlation: between auditory function at the end of the treatment (or after a few cycles of therapy) and the overall dose of CDDP or CBDCA administered. In 16 cases (62%) typical bilateral perceptive deafness was detected progressively involving the hyperacute and acute frequencies. The finding of hearing loss was significantly greater in the patients treated with CDDP (86%) vs. those treated with CBDCA (33%). Moreover, analysis of the results showed that, within certain limits, ototoxicity can depend more on individual sensitivity to the drug than to the total dose administered. The results confirm the well-known ototoxicity of platinum compounds, in particular CDDP. As ever improved therapeutic results are achieved in the treatment of malignant neoplasms in pediatric patients, greater attention can be paid to the quality of life of these young patients after the disease has been healed. Careful monitoring of auditory function can be extremely important in the pursuit this objective; indeed, this makes it possible to adjust antiblast drug administration, particularly in the later stages of treatment, customizing the treatment schedule to individual patient sensitivity.
Montaguti
M
M
Dipartimento di Scienze Chirurgiche ed Anestesiologiche, Sezione di Otorinolaringoiatria, Ospedale S. Orsola-Malpighi, Università di Bologna.
Brandolini
C
C
Ferri
G G
GG
Hatzopoulos
S
S
Prete
A
A
Pession
A
A
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016190:Carboplatin / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000009:adverse effects*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin