Late anthracycline cardiotoxicity has been of increasing concern to pediatric oncologists. An increasing number of patients with cardiac dysfunction has been reported without a good correlation between cardiac function or symptoms and routine echocardiographic follow-up. We studied dobutamine stress echocardiography in patients who had received moderate doses of anthracyclines years before. Twenty-three patients (14 male, 9 female; 7-25 y) who completed chemotherapy with moderate doses of anthracyclines (180-380 mg/m2) more than 2 y previously underwent dobutamine stress echocardiography and were compared with a control group of 26 healthy young people (15 male, 11 female; 6-26 y) matched for age and weight. Dobutamine was administered in three periods up to a rate of 5 micro g/kg/min. Eighty-five percent of the patients showed an abnormal response to dobutamine. Both systolic and diastolic functions were affected. The systolic dysfunction was not related to diminished contractility but to an elevated systolic wall stress due to inadequate cardiac muscle thickening. The diminished wall thickening was related to the length of follow-up. Dobutamine proved to be a very sensitive method to detect clinical and subclinical cardiac dysfunction in patients post anthracycline chemotherapy and questions the concept of a safe dose.
Background: Patients with fibromatosis not amenable
to surgery may suffer from high morbidity. Various
chemotherapeutic regimens have been tried in these patients
with limited success. Here, we report on the successful
use of pegylated liposomal doxorubicin in the
treatment of 4 patients with unresectable fibromatosis in
unfavorable localizations. Patients and Methods: 3 children
and 1 adult with progressive fibromatosis were
treated with 3-weekly cycles of chemotherapy with liposomal
doxorubicin (dose range 20-50 mg/m2 per day
every 21 days). Tumors were located at the nasal cavity,
fossa infratemporalis, oral cavity, abdomen, and fossa
supraclavicularis and were unresectable. 3 of the 4 patients
had been heavily pretreated with various chemotherapeutic
agents. Objective tumor response was monitored
by magnetic resonance imaging and possible cardiotoxicity
by echocardiography at regular intervals. Results:
A tumor response was obtained in all 4 patients.
All patients showed normal cardiac function after completion
of chemotherapy as evaluated by left ventricular
shortening fraction. Severe neutropenia was not observed.
Conclusion: Pegylated liposomal doxorubicin is a
therapeutic option in patients with progressive unresectable
fibromatosis in unfavorable localizations.
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