New Guideline Recommends Sodium Thiosulfate to Prevent Cisplatin-Induced Ototoxicity

By Will Boggs MD

January 22, 2020

NEW YORK (Reuters Health) - Sodium thiosulfate can be used to prevent cisplatin-induced ototoxicity in children and adolescents with cancer, according to a new clinical-practice guideline.

"All the recommendations around sodium thiosulfate (STS) will be controversial," Dr. Lillian Sung of The Hospital for Sick Children, in Toronto, Canada, told Reuters Health by email. "STS appears to polarize people to both extremes."

Cisplatin-induced ototoxicity is permanent and progressive. A clinical-practice guideline is available for ototoxicity surveillance, but guidelines are lacking for interventions to reduce ototoxicity in pediatric oncology.

Dr. Sung and colleagues on a multidisciplinary, multinational panel used a systematic review of 27 randomized trials to develop a guideline for the prevention of cisplatin-induced ototoxicity in children and adolescents with cancer.

They strongly recommend sodium thiosulfate for children and adolescents with non-metastatic hepatoblastoma (based on high-quality evidence) and weakly recommend it for those with non-metastatic cancers other than hepatoblastoma (based on low-quality evidence).

Sodium thiosulfate should not, however, be used routinely for patients with metastatic cancer, according to the guideline, in The Lancet Child and Adolescent Health.

The authors strongly recommend against using amifostine or sodium diethyldithiocarbamate for the prevention of cisplatin-induced ototoxicity in these patients, based on high-quality and low-quality evidence, respectively.

Based on low-quality evidence, the guideline strongly discourages both using intratympanic middle-ear therapy and altering cisplatin-infusion duration, as a means in itself, to prevent ototoxicity in these patients.

"Following guidelines can improve patient quality of life," Dr. Sung concluded.

The panel plans to update the guideline in five years or sooner if important new information is published.

SOURCE: Lancet Child and Adolescent Health, online December 19, 2019.