Hearing threshold differences postcis-platinum, relative to precis-platinum levels, were studied in 21 men from a Veterans Administration Medical Center. These patients had previously untreated advanced epidermoid cancers of the head and neck. Each patient received one of three drug combinations: (I) cis-platinum, Oncovin, and bleomycin (n = 9); (2) cis-platinum and 5-fluorouracil (n = 7); or (3) cisplatinum and bleomycin (n = 5). Wide variations in prechemotherapy hearing thresholds prevented analysis among various drug combinations. Therefore, the three groups were pooled to compare the thresholds by frequency. The frequencies tested and analyzed were: 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz. Significant differences were found at 2000 Hz (P < 0.01) and 8000 Hz (P < 0.05). Any existing ototoxic effects of cis-platinum may have been overridden by already high prechemotherapy hearing thresholds at 4000 Hz. Since 2000 Hz was most sensitive to the ototoxic effects of cis-platinum it is suggested that this frequency be monitored routinely as a part of standard chemotherapy assessment.
Cancer 51:610-613, 1983.
ENERALLY, most studies indicate that a combina-G tion of chemotherapeutic drugs will produce higher remission rates than do single agents in patients with previously untreated head and neck cancer.'-4 One of the most clinically beneficial antineoplastic agents used in combination regimens for the treatment of head and neck cancer is cis-diaminedichloroplatinum (DDP).'.' Cis-platinum, however, has many side effects including renal and ototoxi~ity.~.' Although nephrotoxicity can be reduced by using diuresis and hydration these preventive measures do little to obviate ototoxicity.8 Ototoxicity has manifested itself in tinnitus,' and hearing loss.'-" Cochlear and vestibular toxicities are Supported, in part, by NCI Contract CM-87219.