Abstract
Childhood long-term survivors now experience significant late effects from the primary cancer itself or from therapy. Cisplatin, an alkylating agent used in treatment for osteosarcoma, has been associated with irreversible high-frequency sensorineural hearing loss. There were 27 osteosarcoma patients treated at Department of Pediatrics, National University Hospital from 1997 to 2005. Twelve of these were long-term survivors, i.e. survived more than 2 years from initial diagnosis.
Pre-chemotherapy audiogram was performed in 50% (n=6) of patients and the audiogram results were not available in the remainder (n=6, 50%) as it was either not done or records were not available. Prior to year 2003, Cisplatin was administered at a dose of 100mg/ m2/course (EOI regimen) in 50% of cases, and after year 2003, 120mg/m2/course (T12 regimen) in 45%. Median cumulative dose of cisplatin was 550mg/m2 (cumulative dose range, 240 – 800 mg/m2). Out of 12 patients, 7 patients (58%) experienced cisplatin induced ototoxicity. According to NCI Toxicity Criteria, Grade I ototoxicty was observed in two cases (30%), grade 2 toxicity in five cases (70%), and bilateral sensorineural hearing loss was noted in six of the survivors. One long term survivor required a hearing aid. Six of them had and renal tubulopathy (NCI Toxicity Grade 2) was noted simultaneously in 35% of cases (n=4).
The incidence of cisplatin induced ototoxicity is high in our small series of long-term survivors of osteosarcoma. Baseline pre-chemotherapy testing, close monitoring during treatment and further follow-up are essential for this subset of patients receiving high doses of cisplatin.
The study was funded by Singapore Cancer Syndicate (POU-097)
Correspondence should be addressed to Professor Stefan Bielack, Olgahospital, Klinikum Stuttgart, Bismarkstrasse 8, D-70176 Stuttgart, Germany. Email: s.bielack@klinikum_stuttgart.de
