Risk of Hearing Loss After Chemotherapy for Childhood Cancers

New findings from researchers at Children’s Hospital Los Angeles evaluated factors associated with the development of hearing loss after chemotherapy for pediatric cancer.

“Cisplatin is used to treat a wide range of childhood cancers and cisplatin-induced hearing loss (CIHL) is a common and debilitating toxicity,” wrote the study authors.

This multicenter cohort study included 1,414 children (aged 0-14 years), adolescents, and young adults (aged 15-39 years) who were treated with the chemotherapeutic agent cisplatin for a pediatric tumor and later underwent auditory testing. Participants were followed for a median 3.9 years after diagnosis. The investigators measured the rates of moderate or severe CIHL across various demographic, diagnosis, and treatment groups.

This study was published in The Lancet Child & Adolescent Health.

Overall, 620 patients (43.8%) developed moderate to severe CIHL, with 59.4% of these cases occurring among patients aged less than 5 years. Around half of patients with central nervous system (CNS) tumors, 65.9% of patients with hepatoblastoma, and 62.1% of patients with neuroblastoma developed moderate or severe CIHL following treatment with cisplatin.

Higher fractionated doses were found to be associated with increased risk for CIHL, even after adjustment for cumulative dose. Each 10 mg/m² increase in dose per day was associated with an adjusted odds ratio [aOR] of 1.15 (95% confidence interval [CI] 1.07-1.25), compared with 2.16 for each 50mg/m² increase per cycle (95% CI 1.37-3.51).

“We found that how we infuse the drug can significantly alter the risk of side effects,” said study lead Etan Orgel, MD, in a press release. “Cisplatin has been used to treat cancers in children and adults for more than fifty years, but for the first time, we have insights into how something as simple as adjusting our dosing approach may prevent hearing loss and still maintain effective treatments.”

Concurrent use of vincristine, another chemotherapy agent, was also identified as risk factor for CIHL (aOR 3.55; 95% CI 2.1905.84). Neither moderate now severe CIHL were significantly associated with survival differences.

“We’ve developed these powerful tools to effectively fight cancer,” said Dr. Orgel. “Now we can focus in on how to use these tools in a way that maintains their power but minimizes their footprint.”

Children with cancer who have #cisplatin-based chemotherapy are at risk for #hearingloss. New research investigates the burden and risk factors: essential for guiding practitioner discussions and deciding treatment options #childhoodcancer #oxotoxicity https://t.co/511G6DbsQ1 pic.twitter.com/xO5cUz2VgD

— The Lancet Child & Adolescent Health (@LancetChildAdol) February 15, 2021

Cisplatin is a chemotherapy agent used in about half of #pediatriccancer cases. Hearing loss is a common side effect of cisplatin. New research from @ChildrensLA shows that cisplatin dosage & administration affect the risk of hearing loss. https://t.co/Z2OrId0vkH #NIDCDgrantee

— NIH NIDCD (@NIDCD) February 16, 2021