Auditory late effects of childhood cancer therapy: a report from the Children's Oncology Group

Abstract

Children treated for malignancies may be at risk for early- or delayed-onset hearing loss that can affect learning, communication, school performance, social interaction, and overall quality of life. Survivors at particular risk include those treated with platinum compounds (cisplatin and/or carboplatin) for neuroblastoma, hepatoblastoma, osteosarcoma, or germ-cell tumors and/or those treated with radiation that affects the ear at doses of >30 Gy for pediatric head and neck tumors. The aims of the Auditory/Hearing Late Effects Task Force of the Children's Oncology Group in this report were to (1) review ototoxicity resulting from childhood cancer therapy including platinum compounds (cisplatin and carboplatin) and radiation, (2) describe briefly cochlear pathophysiology and genetics of cisplatin-related hearing loss, (3) explain the impact of hearing loss resulting from chemotherapy and radiation, and (4) offer recommendations regarding evaluation and management of pediatric patients who are at risk for treatment-related hearing loss. A questionnaire is included as a tool to assist pediatricians in assessment.

Figure 1

Frequency composition (spectra) and approximate intensity ranges, within conversational speech, for different categories of speech sounds. From Hall JW, Mueller HG (eds) Audiologist’s Desk Reference, with permission.

Figure 2

Figure 2A. Progressive hearing loss with increasing cycles of cisplatin chemotherapy with threshold effect [with permission from Schell et. al] Figure 2B. Median time to hearing loss [with permission from Knight KR et. al]

Figure 3

Sequential audiometry in a 4 year-old diagnosed with neuroblastoma: pre-chemotherapy (A); after completing treatment including 400 mg/m² of cisplatin (B); and following full therapy with cisplatin 400 mg/m² along with carboplatin 1,700 mg/m² (C).[Modified from Knight KR et. al with permission ]

Figure 4

Probability of hearing loss at various frequencies related to cumulative dose of cisplatin. A=group that did not receive cranial irradiation, B=group that received cranial irradiation [with permission from Schell et al ]

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