CARDIAC TOXICITY 4 TO 20 YEARS AFTER COMPLETING ANTHRACYCLINE THERAPY
CARDIAC TOXICITY 4 TO 20 YEARS AFTER COMPLETING ANTHRACYCLINE THERAPY
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DOI：
10.1001/jama.266.12.1672
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发表时间：
1991-09-25
影响因子：
120.7
通讯作者：
MURPHY, ML
中科院分区：
文献类型：
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作者：
STEINHERZ, LJ;STEINHERZ, PG;MURPHY, ML
目标。-评估接受化疗（包括蒽环类药物）的儿科恶性肿瘤长期幸存者的心脏状况。设计与方法。患者在蒽环类药物治疗结束后4 - 20年（中位7年）通过超声心动图进行评估，并进行前瞻性和回顾性分析。-连续201例患者接受了总蒽环类药物剂量200 - 1275 mg/m2（中位450 mg/m2）， 51例患者接受了纵隔放疗。主要结果测量。-确定整个队列中收缩期心功能异常的总发生率和严重程度。检查蒽环类药物总剂量、纵隔放疗、治疗期间年龄、随访时间等危险因素。在长期随访中，23%（47/201）的队列患者在无创检测中出现心功能异常。总累积剂量、随访时间和纵隔照射与异常发生率之间存在显著相关性。56例患者随访10年或更长时间（中位12年），蒽环类药物中位剂量为495 mg/m2。这些患者中有38%（21/56）有异常发现，相比之下，不到10年评估的患者中有18%（26/145）有异常发现。在接受500mg /m2以上蒽环类药物治疗后随访10年或更长时间的患者中，有63%出现异常。201例患者中有9例出现晚期症状，包括心力衰竭和心律失常，3例患者突然死亡。心肌组织活检及尸检镜检显示心肌纤维化。- 23%的晚期心脏异常发生率值得对蒽环类药物后患者进行持续评估，以指导患者护理和未来化疗方案的设计。
Objective. - To assess the cardiac status of long-term survivors of pediatric malignancies who received chemotherapy, including anthracyclines.Design and Method. - Patients were evaluated by echocardiogram from 4 to 20 years (median, 7 years) after completion of anthracyclines, with prospective and retrospective analysis.Patients. - The consecutive sample of 201 patients had received a total anthracycline dose of 200 to 1275 mg/m2 (median, 450 mg/m2), and 51 patients had mediastinal radiotherapy.Main Outcome Measures. - The overall incidence and severity of abnormal systolic cardiac function were determined for the entire cohort. Risk factors of total anthracycline dose, mediastinal radiotherapy, age during treatment, and length of follow-up were examined.Results. - Twenty-three percent (47/201) of the cohort had abnormal cardiac function on noninvasive testing at long-term follow-up. Correlation between total cumulative dose, length of follow-up, and mediastinal irradiation with incidence of abnormalities was significant. Fifty-six patients were followed up for 10 years or more (median, 12 years), with a median anthracycline dose of 495 mg/m2. Thirty-eight percent (21/56) of these patients, compared with 18% (26/145) of patients evaluated after less than 10 years, had abnormal findings. Sixty-three percent of patients followed up for 10 years or more after receiving 500 mg/m2 or more of anthracyclines had abnormal findings. Nine of 201 patients had late symptoms, including cardiac failure and dysrhythmia, and three patients died suddenly. Microscopic examination of the myocardium on biopsy and autopsy revealed fibrosis.Conclusion. - The 23% incidence of late cardiac abnormalities warrants continued evaluation of patients after anthracyclines to guide patient care and the design of future chemotherapeutic protocols.