Erselcan T, Kairemo K J, Wiklund T A, Hernberg M, Blomqvist C P, Tenhunen M, Bergh J, Joensuu H
Department of Oncology, Helsinki University Central Hospital, Finland.
Br J Cancer. 2000 Feb;82(4):777-81. doi: 10.1054/bjoc.1999.0998.
We compared adjuvant chemotherapy-related myocardial damage by antimyosin scintigraphy in patients who received either nine cycles of FEC (fluorouracil, epirubicin and cyclophosphamide) where the doses of epirubicin and cyclophosphamide were escalated according to the leucocyte nadir (group I, n = 14), three cycles of FEC followed by high-dose chemotherapy with alkylating agents (CTCb) given with the support of peripheral blood stem cell transplantation (group II, n = 14), or six cycles of standard intravenous CMF (cyclophosphamide, methotrexate and fluorouracil; group III, n = 8). The cardiac uptake of In-111-antimyosin-Fab (R11D10) antibody was measured and the heart-to-lung ratio (HLR) calculated 8-36 months after the last dose of chemotherapy. Cardiac antimyosin antibody uptake was considerably higher among patients treated with nine cycles of dose-escalated FEC than among those who were treated with three cycles of FEC and high-dose CTCb (HLR, median 1.98; range 1.36-2.24 vs median 1.51; range 1.20-1.82; P < 0.001), or those treated with CMF (median 1.44; range 1.15-1.68; P < 0.001). The difference between groups II and III was not significant (P > 0.1). A linear association was found between the cumulative dose of epirubicin and the cardiac antimyosin uptake (P < 0.001). We conclude that subclinical cardiac damage caused by three cycles of conventional-dose FEC followed by one cycle of high-dose CTCb chemotherapy is small as compared with the damage caused by dose-escalated FEC.
我们通过抗肌凝蛋白闪烁扫描术比较了接受9个周期FEC（氟尿嘧啶、表柔比星和环磷酰胺）治疗的患者（表柔比星和环磷酰胺剂量根据白细胞最低点进行递增，第I组，n = 14）、接受3个周期FEC后再进行高剂量烷化剂化疗（CTCb）并辅以外周血干细胞移植治疗的患者（第II组，n = 14）或接受6个周期标准静脉注射CMF（环磷酰胺、甲氨蝶呤和氟尿嘧啶；第III组，n = 8）的患者中与辅助化疗相关的心肌损伤情况。在最后一剂化疗后8 - 36个月测量铟 - 111抗肌凝蛋白 - Fab（R11D10）抗体的心脏摄取量，并计算心/肺比值（HLR）。接受9个周期剂量递增FEC治疗的患者中，心脏抗肌凝蛋白抗体摄取量显著高于接受3个周期FEC和高剂量CTCb治疗的患者（HLR，中位数1.98；范围1.36 - 2.24，对比中位数1.51；范围1.20 - 1.82；P < 0.001），也高于接受CMF治疗的患者（中位数1.44；范围1.15 - 1.68；P < 0.001）。第II组和第III组之间的差异不显著（P > 0.1）。发现表柔比星的累积剂量与心脏抗肌凝蛋白摄取之间存在线性关联（P < 0.001）。我们得出结论，与剂量递增的FEC相比，3个周期常规剂量FEC后再进行1个周期高剂量CTCb化疗所导致的亚临床心脏损伤较小。
