Vestibulotoxicity Associated With Platinum-Based Chemotherapy in Survivors of Cancer: A Scoping Review

Abstract

Background: Cochleotoxicity following the treatment with platinum-based chemotherapy is well documented. The potential for vestibulotoxicity is still unclear. This scoping review examined the extent of current research literature, summarized research findings and identified research gaps regarding vestibular-related adverse effects associated with platinum-based chemotherapy in survivors of cancer.Methods: Inclusion criteria followed the PICO principles: Participants, adult, and pediatric cancer patients of any cancer type; Intervention, platinum-based chemotherapy (such as cisplatin, carboplatin, and oxaliplatin); Control, none or any; Outcomes, vestibular-related adverse effects. English language articles published since 1978 were retrieved. Seventy-five eligible studies were identified from a systematic literature search, and relevant data were charted, collated, and summarized.Results: Testing for vestibulotoxicity predominately featured functional evaluation of the horizontal semicircular canal using the caloric and rotational tests. The rate of abnormal vestibular function test results after chemotherapy administration varied from 0 to 50%. The results of objective testing did not always correspond to patient symptoms. There is tentative support for patients with pre-existing loss of vestibular function to be more likely to experience vestibular toxicity after dosing with cisplatin.Conclusions: A number of studies reported significant evidence of vestibular toxicities associated with platinum-based chemotherapy, especially cisplatin. This scoping review emphasizes that vestibular toxicity needs more attention and comprehensive evaluation. Specifically, studies that analyse cumulative dose of platinum-based chemotherapy, affected sites of lesion in vestibular end organs, and the correlation and temporal patterns of cochlear and vestibular toxicity are needed.

A review of movement disorders in chemotherapy-induced neurotoxicity

“…Kneis et al 2020 is the only postural study that assessed vestibular function, finding no vestibular dysfunction in their cohort. However, the rate of abnormal vestibular function after chemotherapy ranges from 0 to 50% [ 45 ]. Furthermore, Wampler et al 2007 found two of the largest postural sway differences between cancer survivors and controls occurred in standing conditions relying on vestibular input, suggestive of vestibular impairments [ 24 ].…”

Audiovestibular clinician experiences and opinions about cisplatin vestibulotoxicity

“…This could be because the degree of otolith dysfunction appears to be less than that of canal dysfunction in bilateral vestibulopathy [16]. None of the studies evaluated otolith function by VEMP in cancer populations who received cisplatin chemotherapy [12]; therefore, its utility has not yet been fully investigated.…”

“…Balance problems such as dizziness and unsteadiness can cause significant negative impact on quality of life [9] and substantial economic burden [10], especially in a vulnerable group of cancer survivors [11]. Whilst the existence of cisplatin vestibulotoxicity is evident [12], the extent, severity, and impact are largely unclear from the literature, and seem to be under-reported and under-investigated.…”

Looking beyond the audiogram in ototoxicity associated with platinum-based chemotherapy

“…Vestibular effects associated with platinum-based chemotherapy are less frequently described in the literature compared to auditory symptoms, but can be debilitating [5]. Vestibular dysfunction can trigger a deterioration of quality of life including physical impairment that interfere with driving, riding a bicycle, and other activities involving good balance, as well as psychological symptoms [53].…”

“…Despite potent efficacy against cancer, ototoxic effects are significantly problematic which limit usage and dosage [2]. Cisplatin has been found to be the most ototoxic agent in the platinum-based chemotherapy group with associated hearing loss [3], tinnitus [4], and imbalance [5]. Carboplatin and oxaliplatin have been demonstrated to be less ototoxic [6], though audiovestibular issues still arise.…”