Incidence, severity, and risk factors of platinum-induced ototoxicity in pediatric oncology patients: A multi-center retrospective study.
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OBJECTIVE: Platinum-based chemotherapeutic agents, particularly cisplatin and carboplatin, are commonly used in pediatric oncology but are frequently associated with ototoxicity. This study aimed to evaluate the incidence, severity, and risk factors of platinum-induced ototoxicity in Korean pediatric cancer patients. METHODS: We conducted a retrospective cohort study across three tertiary hospitals in South Korea, reviewing the medical records of 314 pediatric oncology patients treated with cisplatin or carboplatin between 2004 and 2024. Hearing function was assessed using audiologic evaluations, including pure-tone audiometry, auditory brainstem response (ABR), and distortion product otoacoustic emission (DPOAE). Ototoxicity was defined as a Chang grade of ≥2a or equivalent threshold shifts on ABR/DPOAE. RESULTS: Ototoxicity was identified in 146 patients (46.5%). Hearing loss predominantly affected high frequencies (≥4 kHz), consistent with platinum-induced sensorineural hearing loss. Male sex, a diagnosis of medulloblastoma, and treatment with carboplatin were each significantly associated with increased risk. Patients diagnosed before age 11 exhibited significantly worse thresholds across all frequencies (p < 0.05). Patients who received radiotherapy showed significantly worse thresholds at low frequencies (p < 0.001), although total radiation dose and platinum-treatment duration were not independently correlated with hearing loss. CONCLUSIONS: Nearly half of pediatric patients treated with platinum chemotherapy developed ototoxicity. Younger age, male sex, carboplatin exposure, and head and neck radiotherapy were associated with poorer hearing outcomes, highlighting the need for standardized hearing surveillance in high-risk patients.