New international society of pediatric oncology Boston ototoxicity grading scale for pediatric oncology: Still room for improvement

摘要

Best known for its remarkable effectiveness in successfully treating testicular cancer in adults, cisplatin is a platinum-based chemotherapeutic agent used in many multimodal pediatric cancer treatment regimens. Children with neuroblastoma, hepatoblastoma, retinoblastoma, germ cell tumors, osteosarcoma, medulloblastoma, and other brain tumors are routinely treated with cisplatin, and/or its newer and less toxic analog, carboplatin.1'2 The mechanism of action of these drugs involves covalent binding to purine DNA bases, leading to cellular apoptosis.1'3 The dose-limiting factors in the administration of platinum-based drugs are generally nephrotoxicity (cisplatin) or myelosuppression (carboplatin), but cisplatin in therapeutic doses is highly ototoxic.4 Carboplatin, although with substantially less oto-toxic potential than cisplatin,3 is associated with a high risk for hearing loss when used in combination with cisplatin and when used in my-eloablative doses as conditioning for hematopoietic stem-cell transplantation in children.