Late cardiotoxicity after treatment for a malignant bone tumor.
Cardiac function was assessed in long-term survivors of malignant bone tumors who were treated according to Rosen's T5 or T10 protocol, both including doxorubicin. Thirty-one patients, age 10-45 years (median age 17.8 years) were evaluated 2.3-14.1 years (median 8.9 years) following completion of treatment. Cumulative doses of doxorubicin were 225-550 mg/m2 (median dose 360). The evaluation consisted of a history, physical examination, electrocardiogram (ECG), signal averaged ECG, 24-hour ambulatory ECG, echocardiography and radionuclide angiography. Eighteen of 31 (58%) patients showed cardiac toxicity, defined as having one or more of the following abnormalities: late potentials, complex ventricular arrhythmias, left ventricular dilation, decreased shortening fraction, or decreased ejection fraction. The incidence of cardiac abnormalities increased with length of follow-up (P< or = .05). No correlation could be demonstrated between cumulative dose of doxorubicin and cardiac status, except for heart rate variability. When adjusted to body surface area, the left ventricular posterior wall thickness (LVPW index) was decreased in all patients. The incidence of doxorubicin-induced cardiotoxicity is high and increases with follow-up, irrespective of cumulative dose. Life-long cardiac follow-up in these patients is warranted. The results of our study suggest that heart rate variability and LVPW index could be sensitive indicators for cardiotoxicity.
Postma
A
A
Department of Pediatric Oncology, University of Groningen, The Netherlands.
Bink-Boelkens
M T
MT
Beaufort-Krol
G C
GC
Kengen
R A
RA
Elzenga
N J
NJ
Schasfoort-van Leeuwen
M J
MJ
Schraffordt koops
H
H
Kamps
W A
WA
D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D001830:Body Surface Area; D001859:Bone Neoplasms / Q000188:drug therapy*; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects; D004108:Dilatation, Pathologic / Q000139:chemically induced; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D004452:Echocardiography / Q000187:drug effects; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging / Q000187:drug effects*; D006331:Heart Diseases / Q000139:chemically induced; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011875:Radionuclide Angiography; D013318:Stroke Volume / Q000187:drug effects; D017741:Survivors; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced
D000903:Antibiotics, Antineoplastic; D001761:Bleomycin; D003609:Dactinomycin; D004317:Doxorubicin; D003520:Cyclophosphamide; D008727:Methotrexate