Ettinghausen S E, Bonow R O, Palmeri S T, Seipp C A, Steinberg S M, White D E, Rosenberg S A
Arch Surg. 1986 Dec;121(12):1445-51. doi: 10.1001/archsurg.1986.01400120095016.
Since a combination of surgery and adjuvant high-dose doxorubicin therapy can prolong survival in patients with extremity sarcomas, but at the expense of significant cardiomyopathic changes, we prospectively studied the differences in cardiotoxicity in 118 patients with sarcomas treated with high- vs low-dose doxorubicin therapy following surgery. Cardiac function, as assessed by left ventricular ejection fraction (EF), was determined by standard radionuclide angiography during rest and exercise. No patients in this study developed congestive heart failure. While both regimens produced net decreases in EF during rest and exercise, the high-dose doxorubicin regimen resulted in significantly greater declines in EF than the low-dose protocol. Of patients with normal baseline values, a greater percentage of patients receiving the high-dose regimen developed an abnormal EF than did those receiving the low-dose regimen, even after separating younger from older individuals. Thus, treatment-induced cardiomyopathy appears to be a significant clinical problem after both high- and low-dose doxorubicin therapy. The use of the low-dose regimen decreases the magnitude of the cardiomyopathic changes.
由于手术与辅助高剂量阿霉素治疗相结合可延长肢体肉瘤患者的生存期，但会以显著的心肌病改变为代价，我们前瞻性地研究了118例肉瘤患者术后接受高剂量与低剂量阿霉素治疗时心脏毒性的差异。通过标准放射性核素血管造影在静息和运动状态下测定左心室射血分数（EF）来评估心脏功能。本研究中无患者发生充血性心力衰竭。虽然两种治疗方案在静息和运动时均导致EF净下降，但高剂量阿霉素方案导致的EF下降幅度明显大于低剂量方案。在基线值正常的患者中，接受高剂量方案的患者出现异常EF的比例高于接受低剂量方案的患者，即使将年轻患者与老年患者分开分析也是如此。因此，高剂量和低剂量阿霉素治疗后，治疗引起的心肌病似乎都是一个重要的临床问题。使用低剂量方案可降低心肌病改变的程度。
