title: Risk stratification and pattern of cardiotoxicity in pediatric Ewing sarcoma.
abstract: BACKGROUND
  Anthracycline chemotherapy contributes to improved outcomes in Ewing sarcoma; however, the most feared complication is cardiotoxicity. Echocardiograms were routinely used to monitor cardiac function after anthracycline treatment. Nevertheless, indices chosen to assess cardiac toxicity vary significantly among different centers, and no uniform protocol has been accepted as ideal.
  
  
  METHODS
  This retrospective study included children with Ewing sarcoma treated at Children's Cancer Hospital Egypt over 4years. All echocardiograms and related clinical assessments were reviewed.
  
  
  RESULTS
  In total, 149 patients (median age 11years; range 1-18years) were included. Although all patients had a reduced ejection fraction compared with their baseline echocardiogram, only 39 patients developed cardiotoxicity (26%): 43% acute-onset, 36% chronic early-onset, and 21% chronic late-onset. There were no statistically significant association between the frequency of myocardial dysfunction and risk factors, including age, sex, follow-up duration, cumulative doxorubicin dose, and mediastinal irradiation. Over one-third (39%) of the patients with cardiac toxicity regained normal cardiac parameters, whereas seven patients died of acute cardiac toxicity.
  
  
  CONCLUSIONS
  The routine use of echocardiography to screen for anthracycline-induced cardiac toxicity before and during chemotherapy identified myocardial dysfunction. Early medical intervention can improve cardiac parameters. Improved screening techniques with better sensitivity and predictability are needed.
authors.affiliation: Department of Pediatric Oncology, Children's Cancer Hospital Egypt-CCHE, Egypt; Department of Oncology, Faculty of Medicine Menufeya University, Egypt.
authors.forename: Emad
authors.initials: E
authors.lastname: Moussa
authors.affiliation: Department of Pediatric Oncology, Children's Cancer Hospital Egypt-CCHE, Egypt; Department of Pediatric Oncology, National Cancer Institute-Cairo University, Egypt.
authors.forename: Manal
authors.initials: M
authors.lastname: Zamzam
authors.affiliation: Department of Pediatric Oncology, Children's Cancer Hospital Egypt-CCHE, Egypt; Department of Pediatric Oncology, National Cancer Institute-Cairo University, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kamel
authors.affiliation: Department of Pediatric Oncology, Children's Cancer Hospital Egypt-CCHE, Egypt; Department of Cardiology, Faculty of Medicine, Cairo University, Egypt.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Salah
authors.affiliation: Department of Pediatric Oncology, Children's Cancer Hospital Egypt-CCHE, Egypt; Department of Pediatric Oncology, National Cancer Institute-Cairo University, Egypt.
authors.forename: Iman
authors.initials: I
authors.lastname: Attia
authors.affiliation: Department of Research, Children's Cancer Hospital Egypt-CCHE, Egypt.
authors.forename: Lina
authors.initials: L
authors.lastname: Gaber
authors.affiliation: Department of Research, Children's Cancer Hospital Egypt-CCHE, Egypt. Electronic address: ranin.soliman@57357.org.
authors.forename: Ranin
authors.initials: R
authors.lastname: Soliman
authors.affiliation: Department of Public Health, National Liver Institute, Menufeya University, Egypt.
authors.forename: Sameera
authors.initials: S
authors.lastname: Ezzat
mesh_terms: D000293:Adolescent; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D066126:Cardiotoxicity; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012512:Sarcoma, Ewing / Q000150:complications* / Q000188:drug therapy; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents
keywords: Anthracyclines; Cardiotoxicity; Echocardiography; Ewing sarcoma; Late effects