D'Alto M, Maurea S, Basso A, Polverino W, Bianchi U, Bonelli A, Silvestro P, Salvatore M, Chiariello M
Istituto Nazionale dei Tumori, Fondazione Giovanni Pascale, Napoli.
Cardiologia. 1997 Jun;42(6):611-8.
Anthracyclines are effective chemotherapeutic agents against various malignancies but their therapeutic value is limited by well-known dose-related cardiotoxicity, mainly induced by oxygen free radicals. Left ventricular diastolic and systolic functional abnormalities precede the clinical evidence of cardiotoxicity. The aim of this study was to evaluate the possible cardiotoxicity of epidoxorubicin administered as "high-dose short-term" protocol. Twenty patients (mean age 50.4 +/- 7.9 years) without cardiac disease, affected by advanced breast cancer were studied. All patients were treated with epidoxorubicin as neoadjuvant chemotherapy according to the new protocol "high-dose short-term" (cumulative dose 475.8 +/- 35.6 mg/m2, range 450-600 mg/m2, in 4-6 weeks). The effectiveness of cancer chemotherapy was monitored by clinical evaluation and mammography performed before and after treatment. All patients underwent color Doppler echocardiography and resting radionuclide angiocardiography in baseline condition and 30 +/- 10 days after the last cycle of chemotherapy. All patients showed a significant reduction of tumor lesion after chemotherapy. Left ventricular systolic and diastolic function parameters obtained by echocardiography (fractional shortening 33.1 +/- 4.5% vs 32.4 +/- 4.8%; ejection fraction 63.6 +/- 6.2% vs 62.9 +/- 5.7%; E/A ratio 1.73 +/- 0.64 vs 1.82 +/- 0.67; E wave deceleration time 204 +/- 24.6 ms vs 208.5 +/- 31.7 ms;isovolumetric relaxation time 79 +/- 15.7 ms vs 80 +/- 17.8 ms) and radionuclide angiocardiography (ejection fraction 62.4 +/- 7% vs 61.8 +/- 5.9; peak ejection rate 2.87 +/- 0.44 VTD/s vs 2.74 +/- 0.46 VTD/s; peak filling rate 2.72 +/- 0.54 VTD/s vs 2.6 +/- 0.58 VTD/s) did not show significant changes after treatment. In conclusion, our results suggest that epidoxorubicin administration using the "high-dose short-term" protocol in patients with breast cancer does not induce early significant abnormalities of left ventricular systolic and diastolic function.
蒽环类药物是治疗多种恶性肿瘤的有效化疗药物，但其治疗价值因众所周知的剂量相关心脏毒性而受到限制，这种毒性主要由氧自由基诱导。左心室舒张和收缩功能异常先于心脏毒性的临床证据出现。本研究的目的是评估采用“高剂量短期”方案给予表柔比星可能产生的心脏毒性。对20例（平均年龄50.4±7.9岁）无心脏病的晚期乳腺癌患者进行了研究。所有患者均按照新的“高剂量短期”方案接受表柔比星作为新辅助化疗（累积剂量475.8±35.6mg/m²，范围450 - 600mg/m²，在4 - 6周内）。通过治疗前后进行的临床评估和乳房X线摄影监测癌症化疗的效果。所有患者在基线状态以及化疗最后一个周期后30±10天接受彩色多普勒超声心动图和静息放射性核素血管造影检查。所有患者化疗后肿瘤病灶均显著缩小。通过超声心动图获得的左心室收缩和舒张功能参数（缩短分数33.1±4.5%对32.4±4.8%；射血分数63.6±6.2%对62.9±5.7%；E/A比值1.73±0.64对1.82±0.67；E波减速时间204±24.6毫秒对208.5±31.7毫秒；等容舒张时间79±15.7毫秒对80±17.8毫秒）以及放射性核素血管造影检查结果（射血分数62.4±7%对61.8±5.9；峰值射血率2.87±0.44VTD/s对2.74±0.46VTD/s；峰值充盈率2.72±0.54VTD/s对2.6±0.58VTD/s）在治疗后均未显示出显著变化。总之，我们的结果表明，在乳腺癌患者中采用“高剂量短期”方案给予表柔比星不会引起左心室收缩和舒张功能的早期显著异常。
