[Monitoring cardiotoxicity of anthracyclines in children and possibilities of its prevention].
Chemotherapy is the basic therapeutic method in pediatric oncology. Encouraging results of treatment of tumours in children may be adversely influenced by late side effects of cytostatics. Most serious is the late cardiotoxicity of anthracyclines. The authors analyzed and evaluated in a retrospective study clinical and laboratory findings in patients treated during childhood on account of malignity by chemotherapy containing anthracyclines, and focused their attention on late toxicity and evaluation of the effect of cardioprotection of dexrazoxane (ICRF-187, Cardioxane). The investigation comprised 73 patients aged 15 +/- 4.7 years who were given a cumulative dose of anthracycline (doxorubicin or daunorubicin) 244 +/- 13 mg/m2 and were in long-term remission of the disease. The mean follow up period after terminated chemotherapy was 6.7 +/- 3.4 years. Cardioprotection was administered to 42%, to 58% it was not administered. The authors did not find a significant difference in the results of anthropometric, haematological and biochemical examinations in the two sub-groups. A decrease of the left ventricular ejection fraction below 50% was diagnosed in 4 patients (5% of the group) whereby two developed cardiomyopathies with the clinical picture of heart failure and one patient died due to progressive heart failure. Cardiotoxicity was diagnosed only in the sub-group without cardioprotection (9.5% of the sub-group). In patients without cardiotoxicity in the investigated sub-groups no significant difference was found in the left ventricular ejection fraction at rest or after a stress (in dynamic stress echocardiography), in the tolerance of a stress and circulatory indicators. A significant and relatively close negative relationship was found between the administered cumulative dose of anthracyclines and the left ventricular ejection fraction at rest (r = -0.62, p < 0.001) and after a stress (r = -0.64, p < 0.001).


CONCLUSIONS
The finding of a 5% incidence of cardiac damage of the myocardium in the whole group after a relatively short period after termination of chemotherapy is sufficient reason for long-term cardiological and in particular echocardiographic follow up of patients treated in childhood on account of a malignity with anthracyclines and for a rational approach to the administration of cardioprotection.
Ustav humánní farmakologie a toxikologie, Fakulta farmaceutická Veterinární a farmaceutické univerzity, Brno.
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D000293:Adolescent; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D002648:Child; D005260:Female; D006321:Heart / Q000187:drug effects*; D006801:Humans; D008297:Male; D020011:Protective Agents / Q000008:administration & dosage; D011929:Razoxane / Q000008:administration & dosage*; D012189:Retrospective Studies
D000903:Antibiotics, Antineoplastic; D020011:Protective Agents; D011929:Razoxane