de Matos Neto Ranulfo Pinheiro, Petrilli Antônio Sérgio, Silva Célia Maria Campos, Campos Filho Orlando, Oporto Victor Manuel, Gomes Lourdes de Fátima Gonçalves, Paiva Marcelo Goulart, Carvalho Antônio Carlos Camargo, Moisés Valdir Ambrósio
Universidade Federal de São Paulo e Instituto de Oncologia Pediátrica, Escola Paulista de Medicina, São Paulo, SP, Brazil.
Arq Bras Cardiol. 2006 Dec;87(6):763-71. doi: 10.1590/s0066-782x2006001900013.
To evaluate left ventricular (LV) systolic function by means of echocardiography in patients with osteosarcoma treated with doxorubicin alone or in combination with dexrazoxane.
The study analyzed 55 patients with osteosarcoma, with or without metastasis, undergoing a six-cycle chemotherapy regimen of doxorubicin, who were divided into two groups according to dexrazoxane use. Group I: Thirty-seven patients who did not receive dexrazoxane (28 males, average age 15.4 years). Group II: Eighteen patients who did receive dexrazoxane (15 males, average age 15.1 years). Four echocardiographic evaluations were performed: 1) before the beginning of the chemotherapy (initial evaluation); 2) up to two weeks after the third cycle; 3) up to two weeks after the fifth cycle; and 4) up to four weeks after the sixth cycle of chemotherapy (final evaluation). The left ventricular systolic function was assessed by the fractional percentage of systolic shortening (FS%) on echocardiography. Alterations in the contractile function or cardiac toxicity were defined as FS% values equal to or lower than 29%, and/or by a drop in FS% by an absolute value equal to or greater than 10 units of the baseline value of each patient.
No significant difference as to age, gender, and race was observed between the groups. The cumulative dose of doxorubicin was significantly higher in group II throughout all phases of the treatment: 174 x 203 mg/m(2); 292 x 338 mg/m(2) and 345 x 405 mg/(2) (p < 0.0001). According to previously established criteria, the incidence of LV systolic dysfunction was not significantly different (p=0.248) between patients in group I (18.92%) and patients in group II (11.1%). The variance analysis with repeated measurements did not show significant differences in the means of fractional percentage of systolic percentage (FS%) throughout the study (p=0.967). However, a significant difference (p=0.029) was observed between the FS% means in groups I and II at evaluations 2 (35.67 x 37.21%), 3 (34.95 x 38.47%) and 4 (35.26 x 38.22%).
Data in this study show that in patients with osteosarcoma treated with doxorubicin alone or combined with dexrazoxane, the LV systolic function, as assessed by the fractional percentage of systolic shortening mean, showed a better performance in the group that received dexrazoxane. On the other hand, the occurrence of systolic dysfunction was similar in both groups.
通过超声心动图评估单独使用阿霉素或联合右丙亚胺治疗的骨肉瘤患者的左心室（LV）收缩功能。
该研究分析了55例骨肉瘤患者，无论有无转移，均接受六个周期的阿霉素化疗方案，并根据右丙亚胺的使用情况分为两组。第一组：37例未接受右丙亚胺的患者（28例男性，平均年龄15.4岁）。第二组：18例接受右丙亚胺的患者（15例男性，平均年龄15.1岁）。进行了四次超声心动图评估：1）化疗开始前（初始评估）；2）第三个周期后两周内；3）第五个周期后两周内；4）化疗第六个周期后四周内（最终评估）。通过超声心动图上的收缩期缩短分数百分比（FS%）评估左心室收缩功能。收缩功能改变或心脏毒性定义为FS%值等于或低于29%，和/或FS%较每位患者基线值的绝对值下降等于或大于10个单位。
两组在年龄、性别和种族方面未观察到显著差异。在治疗的所有阶段，第二组阿霉素的累积剂量均显著更高：174×203mg/m²；292×338mg/m²和345×405mg/m²（p<0.0001）。根据先前制定的标准，第一组患者（18.92%）和第二组患者（11.1%）的左心室收缩功能障碍发生率无显著差异（p=0.248）。重复测量的方差分析在整个研究中未显示收缩期百分比分数（FS%）平均值的显著差异（p=0.967）。然而，在评估2（35.67×37.21%）、3（34.95×38.47%）和4（35.26×38.22%）时，第一组和第二组的FS%平均值之间观察到显著差异（p=0.029）。
本研究数据表明，在单独使用阿霉素或联合右丙亚胺治疗的骨肉瘤患者中，通过收缩期缩短平均分数百分比评估的左心室收缩功能在接受右丙亚胺的组中表现更好。另一方面，两组收缩功能障碍的发生率相似。
