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Cardiac abnormalities 15 years and more after adriamycin therapy in 229 childhood survivors of a solid tumour at the Institut Gustave Roussy.
- Source :
- British Journal of Cancer; 7/5/2004, Vol. 91 Issue 1, p37-44, 8p
- Publication Year :
- 2004
-
Abstract
- The purpose of this paper was to determine the cardiac status in children 15 years or more after adriamycin therapy for a solid tumour. Of the 447 pts, 229 pts were fully studied and 218 were not. The following cardiac evaluations were proposed to all the 447 consecutive patients (pts): (1) cardiac Doppler US by one of two expert cardiologists; (2) cardiac rhythm and conduction abnormalities including 24-hour holter ECG; (3) (131)l-mlBG myocardial scintigraphy; (4) serum brain natriuretic peptide levels at rest; (5) an exercise test with VO(2) max measurement. The radiation doses delivered to 6 points in the heart were estimated for all patients who had received radiotherapy. Congestive heart failure was diagnosed in 24 of 229 (10%) evaluated pts, with a median interval of 15 years (0.3-24 years) from the first symptom after adriamycin treatment. Among the 205 remaining pts, 13 asymptomatic pts (6%) had severe (n=4) (FS<20%) or marked (n=9) (20< or =FS<25%) systolic dysfunction. In the 192 others, the median meridional end-systolic wall stress was 91 (53-135) and it exceeded 100 g cm(-2) in 52 pts. Using a Cox model, only the cumulative dose of adriamycin and the average radiation dose to the heart, were identified as risk factors for a pathological cardiac status. In conclusion, the risk of cardiac failure or severe abnormalities increases with adriamycin treatment, radiotherapy and time since treatment, even after a follow-up of 15 years or more. In our series, after an average follow-up of 18 years, 39% of the children had a severe cardiac dysfunction or major ventricular overload conditions. The risk increases with the dose of adriamycin and radiation received to the heart, without evidence for threshold. [ABSTRACT FROM AUTHOR]
- Subjects :
- HEART diseases
DOXORUBICIN
HEART failure
CARDIAC contraction
DRUG therapy
RADIOTHERAPY
ANTINEOPLASTIC antibiotics
RESEARCH
TIME
LEFT ventricular dysfunction
RESEARCH methodology
EVALUATION research
COMPARATIVE studies
DOSE-effect relationship in pharmacology
RADIATION injuries
TUMORS
LONGITUDINAL method
Subjects
Details
- Language :
- English
- ISSN :
- 00070920
- Volume :
- 91
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- British Journal of Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 13597773
- Full Text :
- https://doi.org/10.1038/sj.bjc.6601904