ID #426 Otoprotective Effect of Sodium Thiosulfate in Cisplatin-Based Therapy for Medulloblastoma: Real-World Data from a Low- and Middle-Income Country
Naureen Mushtaq, Farrah Bashir, Ahsan Ahmad, Anjaleen Agrawalla, Soha Zahid, Nadia Ayoub, Anam Fatima, Eric BouffetAbstract
Background and objective
Cisplatin is central to medulloblastoma treatment, but causes ototoxicity in children. Sodium thiosulfate (STS) is a potential otoprotective agent, though evidence from LMICs is limited. This study evaluated STS for preventing cisplatin-induced hearing loss in pediatric medulloblastoma.
Methods
A retrospective study was conducted at Aga Khan University Hospital, comprising children aged 0-18 years, with medulloblastoma treated with cisplatin-based chemotherapy between 2014 and 2024. Patients were grouped into pre-STS (cisplatin alone) and STS (cisplatin plus STS) cohorts. Pre and post-treatment audiometric and clinical assessments were reviewed, with hearing loss classified as mild, moderate, or severe. IBM SPPS27 was used, utilizing Fisher’s exact test, with p < 0.05 considered statistically significant.
Results
Thirty-three patients (Pre-STS: 16, 48.5%; STS: 17,51.5%) were included with a median age of 9.5 years, and 78.8% of the cohort were male. Six patients (18.2%) had prior hearing loss. The most prevalent symptoms were headache (84.9%), vomiting (87.9%), and hydrocephalus (75.8%). Hearing loss was observed in eight patients (50%) within the pre-STS group and in two patients (11.8%) within the STS group; both of these patients experienced severe hearing loss, with one having a history of mild hearing loss. Electrolyte levels remained stable in patients administered STS, with no clinically significant adverse events reported. Among the eight patients with metastatic disease at baseline, four died during follow-up, with equal mortality observed in the pre-STS and STS groups (two deaths in each group).
Conclusion
STS use with cisplatin was associated with a significant reduction in CIHL in pediatric medulloblastoma patients, without added toxicity or adverse survival impact. Its low cost and feasibility make it a valuable otoprotective strategy in LMIC settings. Prospective studies with standardized audiometric follow-up are needed to confirm these findings and guide broader implementation.