Present Risk of Anthracycline or Radiation-induced Cardiac Sequelae Following Therapy of Malignancies in Children and Adolescents

Abstract

Anthracyclines are very potent drugs in the therapy of malignancies in childhood. The major dose limiting adverse effect of these drugs is the risk of dilated cardiomyopathy. We performed a retrospective study on 168 patients who were treated with anthracyclines for a malignant disease with or without chest radiation at the department of Pediatric Hematology and Oncology at the University of Duesseldorf between 2000 and 2004. During and after chemotherapy the patients were screened by echocardiography and ECG examinations prior to each administration of anthracyclines. Only four patients presented with adverse cardiac events, one of whom developed acute cardiac failure. This patient was additionally treated with chest radiation. Three of the four patients showed intermittent arrhythmias, mainly supraventricular tachycardia. One of them presented with atrial ectopic tachycardia and left ventricular dysfunction. We conclude that the frequency of cardiac sequelae after chemotherapy with anthracyclines is low under present guidelines. Detection of early cardiac sequelae may be more difficult than in the past. Only one patient with cardiac sequelae in our study group was diagnosed by regular performed examinations for cardiac sequelae of chemotherapy. We therefore need to modify our screening methods to increase the effectiveness of detection of cardiac dysfunction prior to clinical manifestation.

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

“…55,452,453 These changes have been found primarily in adults, with only a 2% incidence of supraventricular tachycardias reported in children during treatment with anthracyclines. 454 Only scattered reports address the issue of arrhythmias late after chemotherapy. A study of 11 children reported that anthracycline treatment may be a risk factor for torsade de pointes weeks or years after therapy for leukemia, and such cases are generally related to QT-prolonging agents or to hypokalemia.…”

Meme kanseri nedeniyle radyoterapi uygulanan hastalarda Tp-e aralığı ve Tp-e/QT oranının prospektif olarak incelenmesi

“…Furthermore, in order to prevent arrhythmias related to cancer treatment, Herman recommended identifying patients with ECG changes before treatment and eliminating other comorbidities that predispose these patients to arrhythmias. 21 Chen et al 22 retrospectively evaluated 168 patients treated for pediatric malignancy in terms of cardiotoxicity.…”

Recombinant human neuregulin-1β is protective against radiation-induced myocardial cell injury

“…In addition, chemotherapy drugs affect radiation-induced heart damage. For example, a previous study demonstrated that the use of anthracyclines increased radiation-induced cardiac toxicity (16). Another study indicated that when 240-300 mg/m 2 doxorubicin accumulated, cardiac dysfunction increased after postoperative radiotherapy (17).…”