902P - Cisplatin-induced ototoxicity in head and neck cancer: The patterns and prediction

Background

Cisplatin (CDDP) is the most frequently used chemotherapeutic agent for head and neck cancer (HNC). The objectives of this study were to estimate the incidence rate of CDDP-induced ototoxicity (CIO) and the threshold dose causing ototoxicity, and reveal the related factors in HNC.

Methods

Three hundred and thirty-two patients of HNC received chemotherapy containing CDDP at Kyoto University Hospital from June 2009 to December 2022. The distortion product otoacoustic emission (DPOAE), tympanometry (TPG), and pure-tone audiometry (PTA) were measured after each administration of CDDP. Patients with bilateral conductive hearing loss, and/or the ear side with otitis media were excluded. The factors associated with CIO synergistically were investigated by evaluating the baseline characteristics.

Results

A total of 304 of the 332 patients were included in the analysis. The mean age before CDDP administration was 60.5 years (range, 24-79). Primary sites were nasopharynx (6.6%), oropharynx (21.1%), hypopharynx (20.7%), larynx (7.2%), oral cavity (28.3%), paranasal sinuses (8.9%), and other sites (7.2%). The mean cumulative CDDP doses were 200.0 mg/m2 (range, 48- 800, median 190.0). Dose-dependent hearing threshold shift was observed mainly in the high-frequency speech range. The incidence rate of ototoxicity detected by DPOAE and PTA were 46.4% and 37.8%, respectively. The median cisplatin doses causing deterioration of DPOAE were lower than PTA (210.0 mg/m² v.s.258.0 mg/m², p < 0.05). Above 300 mg/m² of cumulative CDDP dose, CIO was detected in 56.5% by PTA. Related factors for CIO were the cumulative doses of CDDP, concurrent use of radiotherapy, and high-frequency hearing impairment before treatment (p < 0.05, respectively).

Conclusions

Implicit hearing loss caused by CDDP was observed at dose of 211 mg/m², although subjective hearing loss appeared at dose of 258 mg/m². Cumulative doses of CDDP, concurrent use of radiotherapy, and high-frequency hearing impairment before treatment were identified as risk factors for CIO. Monitoring of hearing level is suggested for early detection of CIO especially in patients with high-frequency hearing impairment before treatment.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.