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.

Zusammenfassung

Anthrazykline sind wichtige Chemotherapeutika in der Behandlung maligner Erkrankungen im Kindesalter. Das Risiko einer dilatativen Kardiomyopathie ist die wichtigste dosislimitierende Nebenwirkung. Wir führten eine retrospektive Studie an 168 Patienten durch, welche im Rahmen der Therapie einer malignen Erkrankung mit Anthrazyklinen und/oder thorakaler Bestrahlung in der Klinik für Kinder-Onkologie, -Hämatologie und -Immunologie Düsseldorf zwischen 2000 und 2004 behandelt wurden. Die Patienten wurden während und nach der Therapie mittels Echokardiographie und EKG-Untersuchung, welche jeweils direkt vor der nächsten Anthrazyklingabe durchgeführt wurden, untersucht. Insgesamt zeigten nur vier Patienten kardiale Nebenwirkungen, wovon einer eine akute Herzinsuffizienz entwickelte. Dieser Patient erhielt eine zusätzliche thorakale Bestrahlung. Die anderen drei Patienten entwickelten intermittierende, meist supraventrikuläre Tachykardien. Einer dieser Patienten wurde mit einer atrial ektopen Tachykardie und links ventrikulären Funktionseinschränkung auffällig. Unsere Untersuchung zeigt, dass die Häufigkeit kardialer Nebenwirkungen nach Chemotherapie mit Anthrazyklinen nach den heutigen Therapierichtlinien gering ist und dass das Erkennen dieser schwieriger zu sein scheint als in der Vergangenheit. Nur ein Patient mit kardialer Nebenwirkung wurde durch die regelmäßig durchgeführten Untersuchungen erkannt. Daher sollten die Untersuchungsmethoden dahin gehend modifiziert werden, dass kardiale Nebenwirkungen vor einer klinischen Manifestation erkannt werden.

Key words

anthracycline - cardiomyopathy - chemotherapy - childhood - radiation

Schlüsselwörter

Anthrazykline - Kardiomyopathie - Chemotherapie - Kindheit - Bestrahlung

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