Biro K, Noszek L, Prekopp P, Nagyiványi K, Géczi L, Gaudi I, Bodrogi I
National Institute of Oncology, Budapest, Hungary.
Oncology. 2006;70(3):177-84. doi: 10.1159/000093776. Epub 2006 Jun 2.
The characteristics and risk factors of the long-term ototoxic effect of cisplatin in testicular cancer patients was studied by measuring distortion product otoacoustic emissions (DPOAEs), which is a highly sensitive, new method for detecting high-frequency hearing loss.
223 patients with a median follow-up time of 4.27 years (range 0.5-20 years) and a median age of 37 years (range 18-55 years) were assessed by DPOAE. 100 mg/m2 cisplatin were administered per cycle, in EP, BEP, VeIP, VIP or VPB regimens. The control group consisted of 40 testicular cancer patients without chemotherapy (median age 35 years, range 16-54 years). A detailed medical history evaluated audiological risk factors and hearing complaints. DPOAE was measured in eight frequencies from 750 to 8,000 Hz. Paired t test and Mann-Whitney test were used for statistical evaluation.
Symptomatic ototoxicity was observed in 20% of the patients. In patients receiving <or=300 mg/m2 cisplatin, no amplitude changes were detected. Beyond this dose, hearing impairment proved to be dose dependent. Contrary to the literature, not only high frequencies were affected. In patients receiving >or=400 mg/m2, our method could detect significant hearing impairment at lower frequencies that are important for speech perception. At 400 mg/m2, significant amplitude change was detected at 3,000 Hz (p = 0.01); at 500-600 mg/m2, significant amplitude change was detected at 1,500, 2,000 and 3,000 Hz (p = 0.004, 0.0001 and 0.0002, respectively), and at 700 mg/m2 significant amplitude change was detected at 3,000 Hz (p = 0.01). We detected the lowest amplitudes in those 44 patients who had symptomatic ototoxicity. The only statistically significant risk factor was the cumulative dose of cisplatin; neither smoking nor noise exposure were independent risk factors.
DPOAE is a fast, noninvasive and reliable method in detecting late ototoxicity in testicular cancer patients. Contrary to the literature, not only high frequencies are affected. In patients receiving at least 400 mg/m2, using DPOAE we were able to detect significant hearing impairment at lower frequencies that are important for speech perception.
通过测量畸变产物耳声发射（DPOAE）来研究顺铂对睾丸癌患者的长期耳毒性作用的特征及危险因素，DPOAE是一种检测高频听力损失的高灵敏度新方法。
对223例患者进行DPOAE评估，这些患者的中位随访时间为4.27年（范围0.5 - 20年），中位年龄为37岁（范围18 - 55岁）。采用EP、BEP、VeIP、VIP或VPB方案，每周期给予100 mg/m²顺铂。对照组由40例未接受化疗的睾丸癌患者组成（中位年龄35岁，范围16 - 54岁）。通过详细病史评估听觉危险因素及听力主诉。在750至8000 Hz的八个频率上测量DPOAE。采用配对t检验和Mann - Whitney检验进行统计学评估。
20%的患者出现有症状的耳毒性。接受≤300 mg/m²顺铂的患者未检测到振幅变化。超过此剂量，听力损害呈剂量依赖性。与文献报道相反，不仅高频受到影响。在接受≥400 mg/m²顺铂的患者中，我们的方法能够检测到对言语感知重要的较低频率处的显著听力损害。在400 mg/m²时，在3000 Hz处检测到显著的振幅变化（p = 0.01）；在500 - 600 mg/m²时，在1500、2000和3000 Hz处检测到显著的振幅变化（分别为p = 0.004、0.0001和0.0002），在700 mg/m²时在3000 Hz处检测到显著的振幅变化（p = 0.01）。我们在44例有症状耳毒性的患者中检测到最低振幅。唯一具有统计学意义的危险因素是顺铂的累积剂量；吸烟和噪声暴露均不是独立危险因素。
DPOAE是检测睾丸癌患者迟发性耳毒性的一种快速、无创且可靠的方法。与文献报道相反，不仅高频受到影响。在接受至少400 mg/m²顺铂的患者中，使用DPOAE我们能够检测到对言语感知重要的较低频率处的显著听力损害。
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