title: Hearing loss among survivors of childhood brain tumors treated with an irradiation-sparing approach.
abstract: 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.
  
  
  METHODS
  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.affiliation: Children's Center for Cancer and Blood Diseases, Children's Hospital, Los Angeles, CA, USA.
authors.forename: Etan
authors.initials: E
authors.lastname: Orgel
authors.forename: Shveta
authors.initials: S
authors.lastname: Jain
authors.forename: Lingyun
authors.initials: L
authors.lastname: Ji
authors.forename: Liora
authors.initials: L
authors.lastname: Pollick
authors.forename: Stephanie
authors.initials: S
authors.lastname: Si
authors.forename: Jonathan
authors.initials: J
authors.lastname: Finlay
authors.forename: David R
authors.initials: DR
authors.lastname: Freyer
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy*; D016190:Carboplatin / Q000009:adverse effects* / Q000627:therapeutic use; D002675:Child, Preschool; D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D034381:Hearing Loss / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin