Ototoxicity in Children With High-Risk Neuroblastoma: Prevalence, Risk Factors, and Concordance of Grading Scales-A Report From the Children's Oncology Group
Ototoxicity in Children With High-Risk Neuroblastoma: Prevalence, Risk Factors, and Concordance of Grading Scales-A Report From the Children's Oncology Group
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DOI：
10.1200/jco.2013.51.2038
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发表时间：
2014-02-20
影响因子：
45.3
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
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作者：
Landier, Wendy;Knight, Kristin;Bhatia, Smita
目的铂类药物治疗是高危神经母细胞瘤的主要治疗手段。在以前的报告中，铂相关耳毒性的患病率范围为13%至95%;变异性可归因于小样本和不同的分级量表。关于最佳耳毒性分级尚未达成共识。此外，在一个大的统一治疗的高危神经母细胞瘤人群中，听力损失的患病率和预测因素尚不清楚。患者和方法在顺铂单独给药（< 400 mg/m2;暴露1）或顺铂（400 mg/m2）加卡铂（1，700 mg/m2;暴露2）后完成听力测试。听力损失采用四种量表进行分级（美国言语-语言-听力协会; Brock; Chang;和不良事件通用术语标准，第3版[CTCAEv 3]）。诊断时的中位年龄为3.3岁。严重听力损失的患病率因规模而异。对于第一次手术组，患病率范围为8%/Brock至47%/CTCAEv 3（Brock v CTCAEv 3和Chang，P <0.01; CTCAEv 3 v Chang，P = 0.16）;对于第二次手术组，患病率范围为30%/Brock至71%/CTCAEv 3（所有成对比较，P <0.01）。在需要助听器的患者中，49%（Brock）、91%（Chang）和100%（CTCAEv 3）的听力损失被分级为重度。严重听力损失的危险因素包括暴露于顺铂和卡铂相比，顺铂单独和住院治疗infection.Conclusion严重听力损失是高危神经母细胞瘤的儿童中普遍存在。顺铂联合清髓性卡铂暴露显著增加风险。Brock量表低估了严重听力损失，在这种情况下应谨慎使用。(C)2014年美国临床肿瘤学会
Purpose Platinum-based therapy is the mainstay for management of high-risk neuroblastoma. Prevalence of platinum-related ototoxicity has ranged from 13% to 95% in previous reports; variability is attributable to small samples and disparate grading scales. There is no consensus regarding optimal ototoxicity grading. Furthermore, prevalence and predictors of hearing loss in a large uniformly treated high-risk neuroblastoma population are unknown. We address these gaps in our study.Patients and Methods Audiologic testing was completed after administration of cisplatin alone (< 400 mg/m(2); exposure one) or after cisplatin (400 mg/m(2)) plus carboplatin (1,700 mg/m(2); exposure two). Hearing loss was graded using four scales (American Speech-Language-Hearing Association; Brock; Chang; and Common Terminology Criteria for Adverse Events, version 3 [CTCAEv3]).Results Of 489 eligible patients, 333 had evaluable audiologic data. Median age at diagnosis was 3.3 years. Prevalence of severe hearing loss differed by scale. For those in the exposure-one group, prevalence ranged from 8% per Brock to 47% per CTCAEv3 (Brock v CTCAEv3 and Chang, P < .01; CTCAEv3 v Chang, P = .16); for those in the exposure-two group, prevalence ranged from 30% per Brock to 71% per CTCAEv3 (all pair-wise comparisons, P < .01). In patients requiring hearing aids, hearing loss was graded as severe in 49% (Brock), 91% (Chang), and 100% (CTCAEv3). Risk factors for severe hearing loss included exposure to cisplatin and carboplatin compared with cisplatin alone and hospitalization for infection.Conclusion 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. (C) 2014 by American Society of Clinical Oncology