Brock P R, Bellman S C, Yeomans E C, Pinkerton C R, Pritchard J
Department of Haematology and Oncology, Hospitals for Sick Children, London, England.
Med Pediatr Oncol. 1991;19(4):295-300. doi: 10.1002/mpo.2950190415.
A long-term follow-up study was carried out to assess ototoxicity in children who had been treated for a malignant tumour with "standard dose" cisplatin (60-100 mg/m2 per course), and were at least 2 years from stopping treatment. The median age at diagnosis was 2 years 2 months (range 1 month to 13.5 years). On the basis of hearing assessment by pure-tone audiometry, a practical grading system of hearing loss from 0 to 4 is proposed. Moderate to severe high-frequency hearing loss (grade 2-4) was found in half the children and 10 require appropriate hearing aids. The risk of developing ototoxicity increased significantly with the cumulative cisplatin dose (P = 0.027), although there was considerable individual susceptibility. Serial follow-up testing, to a median of 4 years after completion of cisplatin treatment, showed no recovery of hearing in any of these children. We suggest careful monitoring of young children by a consultant audiological physician throughout treatment with cisplatin, particularly when doses of 400 mg/m2 and over have been reached. Alternative chemotherapy should be discussed if grade 2 ototoxicity develops.
开展了一项长期随访研究，以评估接受“标准剂量”顺铂（每疗程60 - 100 mg/m²）治疗恶性肿瘤且停止治疗至少2年的儿童的耳毒性。诊断时的中位年龄为2岁2个月（范围1个月至13.5岁）。基于纯音听力测定的听力评估，提出了一个从0到4的实用听力损失分级系统。半数儿童出现中度至重度高频听力损失（2 - 4级），10名儿童需要佩戴合适的助听器。尽管个体易感性存在差异，但耳毒性发生风险随顺铂累积剂量显著增加（P = 0.027）。顺铂治疗结束后中位随访4年的系列测试表明，这些儿童的听力均未恢复。我们建议在整个顺铂治疗过程中，由听力顾问医师对幼儿进行仔细监测，尤其是当累积剂量达到400 mg/m²及以上时。如果出现2级耳毒性，应讨论采用替代化疗方案。
