Document Detail

Cardiac function in 5-year survivors of childhood cancer: a long-term follow-up study.
MedLine Citation:
PMID:  20660845     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Childhood cancer survivors (CCSs) have an increased risk of morbidity and mortality. We evaluated the prevalence and determinants of left ventricular (LV) dysfunction in a large cohort of long-term CCSs treated with different potentially cardiotoxic therapies.
METHODS: The study cohort consisted of all adult 5-year CCSs who were treated with potentially cardiotoxic therapies and who visited our late effects outpatient clinic. Echocardiography was performed in patients who had received anthracyclines, cardiac irradiation, high-dose cyclophosphamide, or high-dose ifosfamide. Detailed treatment data were registered. Both multivariate linear and logistic regression analyses were performed.
RESULTS: Of 601 eligible CCSs, 525 (87%) had an echocardiogram performed, of which 514 were evaluable for assessment of the LV shortening fraction (LVSF). The median overall LVSF in the whole group of CCSs was 33.1% (range, 13.0%-56.0%). Subclinical cardiac dysfunction (LVSF <30%) was identified in 139 patients (27%). In a multivariate linear regression model, LVSF was reduced with younger age at diagnosis, higher cumulative anthracycline dose, and radiation to the thorax. High-dose cyclophosphamide and ifosfamide were not associated with a reduction of LVSF. Vincristine sulfate was associated with a nonsignificant decrease of cardiac function (P = .07). Epirubicin hydrochloride was as cardiotoxic as doxorubicin when corrected for tumor efficacy, and daunorubicin hydrochloride seemed less cardiotoxic.
CONCLUSIONS: A high percentage (27%) of young adult CCSs have an abnormal cardiac function. The strongest predictors of subclinical cardiac dysfunction are anthracycline dose, cardiac irradiation, and younger age at diagnosis. There is a suggestion that daunorubicin is less cardiotoxic than other anthracyclines.
Helena J van der Pal; Elvira C van Dalen; Michael Hauptmann; Wouter E Kok; Huib N Caron; Cor van den Bos; Foppe Oldenburger; Caro C Koning; Flora E van Leeuwen; Leontien C Kremer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of internal medicine     Volume:  170     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-27     Completed Date:  2010-08-26     Revised Date:  2011-03-23    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1247-55     Citation Subset:  AIM; IM    
Departments of Medical Oncology and Pediatric Oncology, Academic Medical Center, Meibergdreef 9, Amsterdam, the Netherlands.
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MeSH Terms
Anthracyclines / adverse effects
Antineoplastic Combined Chemotherapy Protocols / adverse effects*,  therapeutic use
Child, Preschool
Cohort Studies
Doxorubicin / adverse effects
Epirubicin / adverse effects
Follow-Up Studies
Linear Models
Logistic Models
Multivariate Analysis
Neoplasms / drug therapy*,  radiotherapy*
Netherlands / epidemiology
Prospective Studies
Risk Factors
Ventricular Dysfunction, Left / chemically induced,  diagnosis,  epidemiology*,  etiology*
Reg. No./Substance:
0/Anthracyclines; 23214-92-8/Doxorubicin; 56420-45-2/Epirubicin
Comment In:
Arch Intern Med. 2011 Feb 14;171(3):264; author reply 264-5   [PMID:  21325120 ]

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