Cisplatin ototoxicity - The importance of baseline audiometry
Cisplatin ototoxicity - The importance of baseline audiometry
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DOI：
10.1097/00000421-199906000-00020
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发表时间：
1999-06-01
影响因子：
2.6
通讯作者：
Lavertu, P
中科院分区：
文献类型：
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作者：
Nagy, JL;Adelstein, DJ;Lavertu, P
听力测定在监测顺铂耳毒性中的作用和最佳用途尚未完全确定。听力图是从217例患者在接受以顺铂为基础的食管癌、肺癌或头颈癌化疗前获得的。然后对其中53例患者进行治疗后测听。化疗包括2个（87%）或3个（13%）疗程的顺铂，剂量为20 mg/m2/d，连续静脉输注4天。同时给予5-氟尿嘧啶或紫杉醇，38%的患者同时接受头颈部放射治疗。在250、500、1000、2000、4000、6000和8000 Hz下获得每只耳朵的气导阈值。还计算了三个三频纯音平均值（PTA）。从60岁开始，使用了针对性别的、年龄调整的正常值，以校正老年性耳聋，正常值上限计算为Fragrance平均值加上标准误差的两倍，即25 dB。听力异常的定义为阈值高于任何PTA的正常值> 10 dB，或高于任何单个频率的正常值> 20 dB。听力损失定义为任何PTA超过基线阈值> 10 dB或任何单个频率超过基线阈值> 20 dB。在接受基线测试的217名患者中，发现57名（26%）听力异常超过预期的老年性耳聋。顺铂治疗后的听力图显示，与自身基线相比，53例重新测试的患者中有19例（36%）出现听力损失。通过鼓室压测定法确定，这些受试者中没有一个具有导致听力损失的传导成分。这些观察结果与治疗后随访持续时间和顺铂给药总剂量无关。作者得出结论，在该患者人群中，显著的既存听力异常很常见，即使在低剂量顺铂给药后，也经常发生额外的听力损失。如果要充分解释随访研究，则必须进行基线检测。
The role and optimal use of audiometry in monitoring for cisplatin ototoxicity are incompletely defined. Audiograms were obtained from 217 patients before treatment with cisplatin-based chemotherapy for cancers of the esophagus, lung, or head and neck. Posttreatment audiometry then was conducted in 53 of these patients. Chemotherapy consisted of two (87%) or three (13%) courses of cisplatin at a dose of 20 mg/m(2)/day given as a continuous intravenous infusion over 4 days. Simultaneous 5-fluorouracil or paclitaxel also was given, and 38% received concurrent radiation therapy to the head and neck. Air-conduction thresholds for each ear were obtained at 250, 500, 1000, 2000, 4000, 6000, and 8000 Hz. Three three-frequency pure-tone averages (PTA) also were calculated. Framingham gender-specific, age-adjusted norms were used, beginning at age 60 to correct for presbycusis, and the upper limit of normal was calculated as the greater of the Framingham mean plus twice the standard error, or 25 dB. Hearing abnormality was defined as a threshold >10 dB above the norm for any PTA, or >20 dB above the norm for any individual frequency. Hearing loss was defined as an elevation over baseline threshold of >10 dB for any PTA or >20 dB for any individual frequency. Of the 217 patients who underwent baseline testing, 57 (26%) were found to have hearing abnormality in excess of the expected presbycusis. Post-cisplatin audiograms demonstrated hearing loss in 19 of the 53 retested patients (36%) when compared with their own baseline. As determined by tympanometry, none of these subjects had a conductive component to their hearing loss. These observations were independent of the duration of follow-up after treatment and of the total dose of cisplatin administered. The authors conclude that significant preexisting hearing abnormality is common in this patient population and that, even after low-dose cisplatin administration, additional hearing loss occurs frequently. Baseline testing is mandatory if follow-up studies are to be adequately interpreted.