Hubungan ototoksisitas dan kemoterapi neoadjuvan pada karsinoma nasofaring berdasarkan ASHA, CTCAE, dan DPOAE

Abstract

Latar belakang: Kemoterapi neoadjuvan adalah induksi kemoterapi sebelum radioterapi dengan regimen cisplatin dan 5-Fluorouracil. Kemoterapi cisplatin bersifat ototoksik pada pendengaran sensorineural bilateral progresif dan bersifat irreversible. Kriteria dari American Speech-Language Hearing Association (ASHA) dan Common Terminology Criteria for Adverse Events (CTCAE) merupakan kriteria untuk mengidentifikasi ototoksisitas dengan menggunakan audiometri, selain pemeriksaan Distortion Product Otoacoustic Emissions (DPOAE). Tujuan: Mengidentifikasi hubungan ototoksisitas dengan kemoterapi neoadjuvan pada penderita karsinoma nasofaring (KNF) WHO tipe III menggunakan ASHA, CTCAE, serta DPOAE. Metode: Studi ini adalah penelitian observasional dengan desain cohort. Kriteria inklusi penelitian yaitu penderita baru KNF WHO tipe III, yang mendapatkan kemoterapi regimen standar dan berusia <60 tahun. Kriteria pemeriksaan DPOAE adalah penderita dengan ambang dengar ≤40 dB. Percontoh dilakukan pemeriksaan timpanometri, audiometri, dan DPOAE. Hasil: Terdapat 9 sampel percontoh penelitian. Uji repeated-ANOVA menunjukkan tidak ditemukan perbedaan bermakna pada tiga hasil pengukuran audiometri antara pascakemoterapi pertama, kedua, dan ketiga (p>0,05). Deteksi awal ototoksisitas menggunakan kriteria ASHA menunjukkan sensitivitas sebesar 67% dan dan CTCAE 44%, dibandingkan baku emas menggunakan DPOAE. Kesimpulan: Ototoksisitas cisplatin ditemukan sejak kemoterapi pertama dengan menggunakan pemeriksaan DPOAE walaupun tidak bermakna secara statistik. Kemampuan DPOAE untuk mendeteksi awal ototoksisitas lebih baik dibandingkan kriteria ASHA dan CTCAE yang menggunakan audiometri nada murni.

Kata kunci: Karsinoma nasofaring, ototoksisitas sisplatin, DPOAE, CTCAE, ASHA

ABSTRACT

Introduction: Neoadjuvant chemotherapy is induction chemotherapy before radiotherapy with cisplatin and 5-Fluorouracyl regiment. Chemotherapy cisplatin is ototoxic, leads to frequently progresive and irreversible bilateral sensorineural hearing loss. American Speech-Language Hearing Association (ASHA) and Common Terminology Criteria for Adverse Events (CTCAE) are the criteria to determine ototoxicity with audiometry, beside Distortion Product Otoacoustic Emissions (DPOAE). Purpose: To identify the relationship between ototoxicity with neoadjuvant chemotherapy in patients NPC WHO type III using ASHA, CTCAE, and DPOAE. Method: This observational study approach with cohort design. Inclusion criteria: new patients NPC WHO type III who consented to undergo standard regiment chemotherapy, and age <60 year-old. For DPOAE examination: hearing level ≤40 dB. Exclucion criteria: NPC WHO type III patients who underwent chemotherapy with unconventional standard regiment. Examinations for hearing function conducted with tympanometry, pure tone audiometry, and Distortion Product Otoacoustic Emissions (DPOAE). Result: There were 9 sample in this study. The result of Repeated-ANOVA test showed no significant difference in three audiometry measurements among three series of chemotherapies. Early detection of ototoxicity using ASHA and CTCAE criterias showed sensitivity of 67% and 44% (compared with DPOAE as a gold standard). Conclusion: Cisplatin ototoxicity had occured since the first chemotherapy and detected with DPOAE, but statistically was not significantly related. Early detection of cisplatin ototoxicity with DPOAE was much better than with criteria American Speech-Language Hearing Association (ASHA) and Common Terminology Criteria for Adverse Events (CTCAE), which used pure tone audiometry.

Keywords: Nasopharyngeal carcinoma, cisplatin ototoxicity, DPOAE, CTCAE, ASHA