Left ventricular systolic function assessed by echocardiography in children and adolescents with osteosarcoma treated with doxorubicin alone or in combination with dexrazoxane.
OBJECTIVE
To evaluate left ventricular (LV) systolic function by means of echocardiography in patients with osteosarcoma treated with doxorubicin alone or in combination with dexrazoxane.


METHODS
The study analyzed 55 patients with osteosarcoma, with or without metastasis, undergoing a six-cycle chemotherapy regimen of doxorubicin, who were divided into two groups according to dexrazoxane use. Group I: Thirty-seven patients who did not receive dexrazoxane (28 males, average age 15.4 years). Group II: Eighteen patients who did receive dexrazoxane (15 males, average age 15.1 years). Four echocardiographic evaluations were performed: 1) before the beginning of the chemotherapy (initial evaluation); 2) up to two weeks after the third cycle; 3) up to two weeks after the fifth cycle; and 4) up to four weeks after the sixth cycle of chemotherapy (final evaluation). The left ventricular systolic function was assessed by the fractional percentage of systolic shortening (FS%) on echocardiography. Alterations in the contractile function or cardiac toxicity were defined as FS% values equal to or lower than 29%, and/or by a drop in FS% by an absolute value equal to or greater than 10 units of the baseline value of each patient.


RESULTS
No significant difference as to age, gender, and race was observed between the groups. The cumulative dose of doxorubicin was significantly higher in group II throughout all phases of the treatment: 174 x 203 mg/m(2); 292 x 338 mg/m(2) and 345 x 405 mg/(2) (p < 0.0001). According to previously established criteria, the incidence of LV systolic dysfunction was not significantly different (p=0.248) between patients in group I (18.92%) and patients in group II (11.1%). The variance analysis with repeated measurements did not show significant differences in the means of fractional percentage of systolic percentage (FS%) throughout the study (p=0.967). However, a significant difference (p=0.029) was observed between the FS% means in groups I and II at evaluations 2 (35.67 x 37.21%), 3 (34.95 x 38.47%) and 4 (35.26 x 38.22%).


CONCLUSIONS
Data in this study show that in patients with osteosarcoma treated with doxorubicin alone or combined with dexrazoxane, the LV systolic function, as assessed by the fractional percentage of systolic shortening mean, showed a better performance in the group that received dexrazoxane. On the other hand, the occurrence of systolic dysfunction was similar in both groups.
de Matos Neto
Ranulfo Pinheiro
RP
Universidade Federal de São Paulo e Instituto de Oncologia Pediátrica, Escola Paulista de Medicina, São Paulo, SP, Brazil. ranulfopmatos@hotmail.com
Petrilli
Antônio Sérgio
AS
Silva
Célia Maria Campos
CM
Campos Filho
Orlando
O
Oporto
Victor Manuel
VM
Gomes
Lourdes de Fátima Gonçalves
Lde F
Paiva
Marcelo Goulart
MG
Carvalho
Antônio Carlos Camargo
AC
Moisés
Valdir Ambrósio
VA
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001859:Bone Neoplasms / Q000188:drug therapy*; D002648:Child; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D012516:Osteosarcoma / Q000188:drug therapy*; D011446:Prospective Studies; D011929:Razoxane / Q000008:administration & dosage*; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology
D000970:Antineoplastic Agents; D011929:Razoxane; D004317:Doxorubicin