High Prevalence of Platinum-Related Hearing Loss in Children With High-Risk Neuroblastoma, With Differences According to Audiometry Scales


Key Points

  • Severe hearing loss ranged from 8% to 47% after cisplatin alone and from 30% to 71% after cisplatin/carboplatin, depending on audiometry scale.
  • The Brock scale underestimated severe hearing loss.

The reported prevalence of platinum-associated ototoxicity in children with high-risk neuroblastoma varies widely due to small patient samples and use of disparate grading scales. In a study reported in the Journal of Clinical Oncology, Landier et al in the Children’s Oncology Group assessed platinum-related hearing loss in a large group of patients using several audiometry scales. They found that hearing loss is common, with greater risk of severe hearing loss in patients receiving cisplatin combined with myeloablative carboplatin, and that there are differences among scales in detecting severe hearing loss.

Study Details

The study involved audiologic testing in 333 pediatric patients with high-risk neuroblastoma after administration of cisplatin alone (≤ 400 mg/m2; n = 66) and after administration of cisplatin (400 mg/m2) plus consolidation with myeloablative carboplatin (1,700 mg/m2; n = 267). Hearing loss was graded using the American Speech-Language-Hearing Association (ASHA), Brock, Chang, and Common Terminology Criteria for Adverse Events, version 3 (CTCAEv3) scales.

Range of Hearing Loss

Patients had a median age at diagnosis of 3.3 years. Proportions of patients with hearing loss were  64% with ASHA, 64% with Brock, 71% with Chang, and 69% with CTCAEv4 scales after administration of cisplatin alone (P > .05 overall) and 87%, 87%, 90%, and 86% after administration of cisplatin/carboplatin (P < .05 overall). Proportions of patients with severe hearing loss were 8% with Brock, 32% with Chang (P < .01 vs Chang), and 47% with CTCAEv3 scales (P < .01 vs Brock, P = .16 vs Chang) after cisplatin alone and 30% with Brock, 59% with Chang, and 71% with CTCAEv3 scales (P < .01 for all pairwise comparisons) after cisplatin/carboplatin. 

Hearing aids were required for 29% of patients after cisplatin alone and for 58% after cisplatin/carboplatin. Hearing loss in these patients was graded as severe in 49% of cases on the Brock scale, 91% of cases by the Chang scale, and 100% of cases on the CTCAEv3 scale.

Predictors of Severe Hearing Loss

On multivariate analysis, risk of severe hearing loss was significantly greater after cisplatin/carboplatin vs after cisplatin alone, with odd ratios (OR) of 3.2 (P = .038) on the Brock scale, 3.7 (P < .05) on the Chang scale, and 3.8 (P < .01) on the CTCAEv3 scale. Risk was also significantly increased in patients hospitalized at least once for infection during induction vs those who were not hospitalized for infection on the Brock scale (OR = 5.1, P < .01) and the Chang scale (OR = 2.2, P < .05).

The investigators concluded, “Severe hearing loss is prevalent among children with high-risk neuroblastoma. Exposure to cisplatin combined with myeloablative carboplatin significantly increases risk. The Brock scale underestimates severe hearing loss and should be used with caution in this setting.”

Smita Bhatia, MD, MPH, of City of Hope, Duarte, California, is the corresponding author of the Journal of Clinical Oncology article.

The study was supported by grants from the Children’s Oncology Group and National Cancer Institute.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.