Ototoxicity of cisplatin plus standard radiation therapy vs. accelerated radiation therapy in glioblastoma patients.
OBJECTIVE
To assess the effect of cisplatin (CDDP) plus concurrent radiation therapy on hearing loss.


METHODS
451 patients with glioblastoma multiforme (GBM) were randomly assigned after surgery to: Arm A: Carmustine (BCNU) + standard radiation therapy (SRT); Arm B: BCNU + accelerated radiation therapy (ART: 160 cGy twice daily for 15 days); Arm C: CDDP + BCNU + SRT; or Arm D: CDDP + BCNU + ART. Patients on arms C and D received audiograms at baseline, and prior to the start of RT, and prior to cycles 3 and 6. Otologic toxicities were recorded at each visit.


RESULTS
56% of patients had hearing loss at baseline. 13% and 50% of patients experienced worsening ototoxicity after 1 year of treatment in arms A and B vs. C and D, respectively, with 13% of those on arms C and D experiencing significant ototoxicity (>or= grade 3) at 6 months. Increasing age was associated with an increased risk of ototoxicity.


CONCLUSIONS
Increased exposure to CDDP increases the risk of ototoxicity over time. Older patients are more susceptible to hearing loss with CDDP. The low proportion of patients with clinically significant ototoxicity suggests that baseline screening is unnecessary in GBM patients.
Marshall
Nicole E
NE
Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Ballman
Karla V
KV
Michalak
John C
JC
Schomberg
Paula J
PJ
Burton
Gary V
GV
Sandler
Howard M
HM
Cascino
Terrence L
TL
Jaeckle
Kurt A
KA
Buckner
Jan C
JC
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001932:Brain Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy; D002330:Carmustine / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D005909:Glioblastoma / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy; D034381:Hearing Loss / Q000139:chemically induced*; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D010034:Otitis Media with Effusion / Q000139:chemically induced; D016016:Proportional Hazards Models; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D014012:Tinnitus / Q000139:chemically induced; D016896:Treatment Outcome
D011838:Radiation-Sensitizing Agents; D002945:Cisplatin; D002330:Carmustine