Children's Center for Cancer and Blood Diseases, Children's Hospital, Los Angeles, CA, USA.
Pediatr Blood Cancer. 2012 Jun;58(6):953-8. doi: 10.1002/pbc.23275. Epub 2011 Jul 27.
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.
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.
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.
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.
恶性脑肿瘤的强化、放疗节约型化疗方案改善了非常年幼儿童的生存和神经认知结局。铂类化合物是该方法成功的关键，但与听力损失有关，这显著降低了幸存者的生活质量。本研究旨在确定与 Head Start 和类似放疗节约型方案相关的耳毒性的发生率和严重程度。
对洛杉矶儿童医院使用放疗节约型方案治疗恶性脑肿瘤的儿童进行了回顾性队列研究。确定了患者和治疗特征。主要结局是治疗后的听力状况、助听器需求和听力阈值变化。
29 例患者可评估。最常见的诊断是髓母细胞瘤（n=14）。诊断时的中位年龄为 2.0 岁（范围，0.2-9.2）。从诊断到最近听力评估的中位时间为 1.1 年（平均值 2.4；范围，0.2-17.5）。顺铂和卡铂的累积剂量分别为 281±88mg/m²和 1205±277mg/m²。所有患者均有氨基糖苷类药物暴露。治疗后，18 例患者（62.1%）听力异常，11 例（37.9%）需要助听器。在 4000Hz 时，记录到 30-40dB 的听力损失具有统计学意义。
虽然消除颅放疗极大地改善了该人群的生存率和神经认知及神经内分泌结局，但由于需要铂类化疗，现在临床上显著的听力损失已成为主要的晚期效应。我们的结果表明，在这个脆弱的人群中，需要进行听力监测并开发耳保护策略。
