Late anthracycline cardiotoxicity after childhood cancer

• Published in: Cancer Vol. 97; no. 8; pp. 1991 - 1998
• Main Authors: Sorensen, Keld, Levitt, Gill A., Bull, Catherine, Dorup, Inge, Sullivan, Ian D.
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 15.04.2003
• Subjects: anthracyclines; cancer; cardiotoxicity; children; echocardiography
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.11274

BACKGROUND The objective of the current study was to examine the risk factors for progression in severity of anthracycline‐induced cardiac dysfunction, thereby providing information that is useful in refining cancer treatment regimes and guiding follow‐up. METHODS Serial echocardiograms were performed on 101 acute lymphoblastic leukemia survivors and 83 Wilms tumor survivors after a mean interval of 6.2 years and 6.7 years since last anthracycline dose, respectively, at first study, and after 10.3 years and 11.1 years, respectively, at second study. The paired data were contrasted with data from 100 normal subjects, and potential correlations with follow‐up interval, cumulative dose, cancer diagnosis, gender, age at diagnosis, and growth were explored using univariate and multiple regression techniques. RESULTS The most important predictor of worsening cardiac performance was total anthracycline dose. As a group, patients receiving < 240 mg/m2 showed no deterioration of left ventricular end systolic stress at > 10 years from the end of treatment. CONCLUSIONS Survivors who have received low‐dose anthracycline require cardiac surveillance infrequently. In good prognosis tumors, cumulative anthracycline dose should be maintained at < 250 mg/m2. Cancer 2003;97:1991–8. © 2003 American Cancer Society. DOI 10.1002/cncr.11274 Prospective longitudinal echocardiographic studies in childhood cancer survivors revealed that total anthracycline dose is the most powerful predictor of late cardiotoxicity. As a group, patients who received < 250 mg/m2 exhibited no deterioration of left ventricular function at 10 years follow‐up.