August 2, 2010 — More than one fourth of childhood cancer survivors treated with potentially cardiotoxic therapies have an abnormal cardiac function as young adults, according to new research.
Helena J. van der Pal, MD, with the Department of Medical Oncology, at the Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands, and colleagues reported the findings in the June 26 issue of Archives of Internal Medicine.
According to Dr. van der Pal and colleagues, studies evaluating cardiovascular toxicity in this setting have produced variable results. "Several population based studies observed a 6- to 8-fold increased mortality owing to CVD [cardiovascular disease] among childhood cancer survivors compared with the general population," they note.
To evaluate the incidence of cardiovascular toxicity further, they conducted echocardiograms in 525 young adults who had survived at least 5 years after treatment with potentially cardiotoxic therapies (anthracyclines, cardiac irradiation, high-dose cyclophosphamide, or high-dose ifosfamide). Of those, 514 were assessed for left ventricular shortening fraction (LVSF).
Overall, the median LVSF was decreased by 33.1% (range, 13.0% - 56.0%), and 27% of patients were defined as having subclinical cardiac dysfunction, defined as LVSF of less than 30%.
On multivariate analysis, the strongest predictors of subclinical cardiac dysfunction were higher cumulative anthracycline dose, thoracic irradiation, and diagnosis at a younger age.
High-dose cyclophosphamide and ifosfamide were not associated with a reduction of LVSF, whereas vincristine sulfate was associated with a trend towards decreased cardiac function (P = .07). When adjusted for antitumor efficacy, epirubicin hydrochloride was comparable to doxorubicin in cardiotoxicity, and both seemed more cardiotoxic than daunorubicin hydrochloride.
"Continued monitoring of all childhood cancer survivors treated with potentially cardiotoxic therapy with or without subclinical cardiac dysfunction is necessary to identify (childhood cancer survivors) who could possibly benefit from early treatment, which could avoid further deterioration of cardiac function," the authors conclude.
The study was supported by the Foundation of Pediatric Cancer Research, Amsterdam, the Netherlands. The study authors have disclosed no relevant financial relationships.
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