Sromová T, Strnadová V, Hrstková H
Ustav humánní farmakologie a toxikologie, Fakulta farmaceutická Veterinární a farmaceutické univerzity, Brno.
Vnitr Lek. 2002 Jul;48(7):649-56.
Chemotherapy is the basic therapeutic method in pediatric oncology. Encouraging results of treatment of tumours in children may be adversely influenced by late side effects of cytostatics. Most serious is the late cardiotoxicity of anthracyclines. The authors analyzed and evaluated in a retrospective study clinical and laboratory findings in patients treated during childhood on account of malignity by chemotherapy containing anthracyclines, and focused their attention on late toxicity and evaluation of the effect of cardioprotection of dexrazoxane (ICRF-187, Cardioxane). The investigation comprised 73 patients aged 15 +/- 4.7 years who were given a cumulative dose of anthracycline (doxorubicin or daunorubicin) 244 +/- 13 mg/m2 and were in long-term remission of the disease. The mean follow up period after terminated chemotherapy was 6.7 +/- 3.4 years. Cardioprotection was administered to 42%, to 58% it was not administered. The authors did not find a significant difference in the results of anthropometric, haematological and biochemical examinations in the two sub-groups. A decrease of the left ventricular ejection fraction below 50% was diagnosed in 4 patients (5% of the group) whereby two developed cardiomyopathies with the clinical picture of heart failure and one patient died due to progressive heart failure. Cardiotoxicity was diagnosed only in the sub-group without cardioprotection (9.5% of the sub-group). In patients without cardiotoxicity in the investigated sub-groups no significant difference was found in the left ventricular ejection fraction at rest or after a stress (in dynamic stress echocardiography), in the tolerance of a stress and circulatory indicators. A significant and relatively close negative relationship was found between the administered cumulative dose of anthracyclines and the left ventricular ejection fraction at rest (r = -0.62, p < 0.001) and after a stress (r = -0.64, p < 0.001).
The finding of a 5% incidence of cardiac damage of the myocardium in the whole group after a relatively short period after termination of chemotherapy is sufficient reason for long-term cardiological and in particular echocardiographic follow up of patients treated in childhood on account of a malignity with anthracyclines and for a rational approach to the administration of cardioprotection.
化疗是小儿肿瘤学的基本治疗方法。儿童肿瘤治疗取得的鼓舞人心的结果可能会受到细胞毒性药物晚期副作用的不利影响。最严重的是蒽环类药物的晚期心脏毒性。作者在一项回顾性研究中分析并评估了童年时期因恶性肿瘤接受含蒽环类药物化疗的患者的临床和实验室检查结果，并将注意力集中在晚期毒性以及对右丙亚胺（ICRF - 187，心内直视手术用）心脏保护作用的评估上。该研究包括73名年龄为15±4.7岁的患者，他们接受的蒽环类药物（多柔比星或柔红霉素）累积剂量为244±13mg/m²，且疾病处于长期缓解状态。化疗结束后的平均随访期为6.7±3.4年。42%的患者接受了心脏保护治疗，58%的患者未接受。作者在两个亚组的人体测量、血液学和生化检查结果中未发现显著差异。4名患者（占该组的5%）被诊断出左心室射血分数低于50%，其中两名发展为伴有心力衰竭临床表现的心肌病，一名患者因进行性心力衰竭死亡。心脏毒性仅在未接受心脏保护治疗的亚组中被诊断出来（占该亚组的9.5%）。在所研究的亚组中，无心脏毒性的患者在静息或应激状态下（动态应激超声心动图检查）的左心室射血分数、应激耐受性和循环指标方面未发现显著差异。在所给予的蒽环类药物累积剂量与静息时的左心室射血分数（r = -0.62，p < 0.001）以及应激后的左心室射血分数（r = -0.64，p < 0.001）之间发现了显著且相对密切的负相关关系。
化疗结束后相对较短时间内，全组中心肌损伤发生率为5%这一发现足以成为对童年时期因恶性肿瘤接受蒽环类药物治疗的患者进行长期心脏科尤其是超声心动图随访以及合理应用心脏保护治疗的充分理由。
