151
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152
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Urba SG, Orringer MB, Perez-Tamayo C, Bromberg J, Forastiere A. Concurrent preoperative chemotherapy and radiation therapy in localized esophageal adenocarcinoma. Cancer 1992; 69:285-91. [PMID: 1728358 DOI: 10.1002/1097-0142(19920115)69:2<285::aid-cncr2820690203>3.0.co;2-e] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Twenty-four patients with localized, potentially resectable adenocarcinoma of the esophagus were enrolled in this study to evaluate the use of preoperative chemotherapy and radiation therapy, followed by transhiatal esophagectomy. The patients were newly diagnosed and had received no prior treatment. Radiation therapy consisted of 4900 cGy, administered as 350-cGy fractions 5 days a week for 14 fractions. The chemotherapy consisted of 5-fluorouracil 300 mg/m2/day administered as a continuous 24-hour intravenous infusion for 96 hours each week, concomitantly with the radiation therapy. After a 3-week rest, patients underwent transhiatal esophagectomy. Twenty-two patients could be observed for their responses to the chemotherapy and radiation regimen. Radiographically, 41% showed improvement, 36% had stable disease, and 23% had progression. Nineteen patients underwent surgery; all patients had total gross removal of disease, and two patients had a complete histologic response. All 24 patients could be examined for toxicity assessment. There were three deaths during the treatment period: one patient died of a perioperative complication, one of pneumonia, and one of a myocardial infarction. Eleven patients eventually had pleural and/or pericardial effusions, and six of these were symptomatic. All 24 patients could be examined for survival analysis. The median follow-up for all patients was 12.5 months, with 32.5 months for all surviving patients. Median survival was reached at 11 months. Disease-free survival was 9.5 months. It was concluded that the radiation-fractionation schedule in this preoperative regimen was associated with marked toxicity in the form of pleural and pericardial effusions. There was no improvement in survival compared with historic controls. The role of combined preoperative treatment in this patient population has yet to be determined.
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Affiliation(s)
- S G Urba
- Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0374
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153
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Thyss A, Gaspard MH, Marsault R, Milano G, Frelin C, Schneider M. Very high endothelin plasma levels in patients with 5-FU cardiotoxicity. Ann Oncol 1992; 3:88. [PMID: 1606078 DOI: 10.1093/oxfordjournals.annonc.a058084] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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154
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Abstract
Carmustine (BCNU), a nitrosourea derivative, is an antineoplastic agent used recently for the treatment of human solid tumors and lymphomas in high doses with autologous bone marrow transplantation. Cardiac toxicity related to BCNU has not been described well. Three patients are reported without a history of angina pectoris who had clinical and electrocardiographic evidence of myocardial ischemia during and immediately after BCNU infusion. The incidence, cause, and mechanism of such a side effect are unknown but should be considered in patients receiving high-dose carmustine infusions.
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Affiliation(s)
- S S Kanj
- Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina 27710
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155
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Fonte CE, Cardello F. Chest pain in a cancer patient on chemotherapy. HOSPITAL PRACTICE (OFFICE ED.) 1991; 26:145-6. [PMID: 2071679 DOI: 10.1080/21548331.1991.11704212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- C E Fonte
- Department of Cardiology, Carl T. Hayden Veterans Affair Medical Center, Phoenix
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156
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157
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Lemaire L, Malet-Martino MC, Longo S, Martino R, de Forni M, Carton M. Fluoroacetaldehyde as cardiotoxic impurity in fluorouracil (Roche). Lancet 1991; 337:560. [PMID: 1671927 DOI: 10.1016/0140-6736(91)91353-v] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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158
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Mercke C, Albertsson M, Hambraeus G, Tennvall J, Lillo-Gil R, Samuelsson L, Willén R, Ranstam J. Cisplatin and 5-FU combined with radiotherapy and surgery in the treatment of squamous cell carcinoma of the esophagus. Palliative effects and tumor response. Acta Oncol 1991; 30:617-22. [PMID: 1716448 DOI: 10.3109/02841869109092429] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The combination of cisplatin (90-120 mg/m2) and 5-fluorouracil (5-FU) (1,000 mg/m2/day in continuous infusion for five days) was given for 2-3 cycles, prior to combined radiotherapy and surgery, to 73 patients with esophageal squamous cell carcinoma, 60 with limited disease (LD), and 13 with extensive disease (ED) (i.e. with metastasis) of whom 3 had recurrent disease. Before preoperative radiotherapy among 60 LD patients, 12 (20%) had complete response, 21 (35%) partial response, 25 (42%) had stable disease, and 2 (3%) progressive disease. Swallowing was improved in 35/73 (48%) of the cases. In the resected specimens, no tumor was found in 8/53 (15%) of the cases, microscopic tumor in 18/53 (34%) and macroscopic tumor in 27/53 (51%). In the ED group, complete response of distant metastases was obtained in 6/13 (48%) of the patients, one of whom is still alive with no evidence of disease 62 months after the start of treatment.
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Affiliation(s)
- C Mercke
- Department of Oncology, University Hospital, Lund, Sweden
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159
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Gradishar W, Vokes E, Schilsky R, Weichselbaum R, Panje W. Vascular events in patients receiving high-dose infusional 5-fluorouracil-based chemotherapy: the University of Chicago experience. MEDICAL AND PEDIATRIC ONCOLOGY 1991; 19:8-15. [PMID: 1990260 DOI: 10.1002/mpo.2950190103] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In a retrospective review, 22 of a total of 244 patients (9%) patients with head and neck or gastrointestinal cancer who were treated with infusional 5-fluorouracil (5-FU)-based chemotherapy regimens experienced thrombotic vascular events. These events occurred concurrently with treatment or several months following the completion of therapy and consisted mainly of cardiac arrhythmias, myocardial infarction, sudden death, and thromboembolism. The temporal relationship of these vascular events to the time of treatment suggests that infusional 5-FU may have been the underlying cause.
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Affiliation(s)
- W Gradishar
- Department of Medicine, University of Chicago, IL
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160
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Abstract
5-Fluorouracil is a commonly administered chemotherapy agent that has infrequently been associated with cardiotoxicity. This review highlights the clinical features of this syndrome as described in reports from the medical literature. Clinical and laboratory evidence supporting proposed underlying mechanisms are reviewed.
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Affiliation(s)
- W J Gradishar
- Department of Medicine, Pritzker School of Medicine, University of Chicago
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161
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Jeremic B, Jevremovic S, Djuric L, Mijatovic L. Cardiotoxicity during chemotherapy treatment with 5-fluorouracil and cisplatin. J Chemother 1990; 2:264-7. [PMID: 2230913 DOI: 10.1080/1120009x.1990.11739029] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cardiotoxicity of 5-fluorouracil and cisplatin chemotherapy for esophageal, head and neck and gastric carcinoma was studied. Before treatment all patients had a cardiac evaluation and during treatment serial electrocardiographic (ECG) recordings were performed. In the pre-treatment evaluation signs of cardiovascular disease were found in 31(38.75%) patients. During treatment cardiotoxicity was observed in 12(15%) patients. The incidence of cardiotoxicity was not higher in patients with signs of cardiovascular disease than in those without in the pre-treatment evaluation. The most common signs of cardiotoxicity were chest pain, ST-T wave changes and arrhythmia. This study suggests that patients on 5-fluorouracil and cisplatin treatment should be under close supervision and that the treatment should be discontinued if chest pain and/or arrhythmias are observed.
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Affiliation(s)
- B Jeremic
- KBC Kragujevac, Department of Oncology and Nuclear Medicine, Yugoslavia
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162
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Misset B, Escudier B, Leclercq B, Rivara D, Rougier P, Nitenberg G. Acute myocardiotoxicity during 5-fluorouracil therapy. Intensive Care Med 1990; 16:210-1. [PMID: 2351781 DOI: 10.1007/bf01724805] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 38-year-old man with a colonic carcinoma experienced cardiogenic shock during continuous intravenous treatment with 5-fluorouracil (5-FU), without clinical or electrical signs of coronary insufficiency and with a normal coronary angiogram. His symptoms resolved after eight days of inotropic and vasodilator therapy. Because of the severity of the shock, rechallenge was not performed. This is the first case of acute cardiac failure without coronary ischemia, associated with 5-FU monotherapy. Experimental studies suggest that this adverse effect could be due to myocardial accumulation of 5-FU leading to depletion of high energy phosphate compounds. This might also explain the more frequently seen acute coronary insufficiency due to 5-FU.
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Affiliation(s)
- B Misset
- Service de Réanimation Médico-Chirurgicale, Institut G. Roussy, Villejuif, France
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163
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Berliner S, Rahima M, Sidi Y, Teplitsky Y, Zohar Y, Nussbaum B, Pinkhas J. Acute coronary events following cisplatin-based chemotherapy. Cancer Invest 1990; 8:583-6. [PMID: 2292051 DOI: 10.3109/07357909009018924] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Six patients with no previous signs or symptoms suggestive of coronary artery disease developed acute coronary ischemia/infarction shortly after cis-diamine-dichloroplatinum II (cisplatin) -based chemotherapy. In two patients this was the sole chemotherapeutic agent used. One patient underwent coronary angiography which disclosed no pathology, but following which, while on a calcium channel blocking agent regimen, he had an uneventful course of chemotherapy with cisplatin. Documentation of cisplatin-related vascular events is important in view of the growing number of patients who undergo cisplatin-based chemotherapy.
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Affiliation(s)
- S Berliner
- Department of Internal Medicine, Beilinson Medical Center, Petah Tikva, Israel
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164
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Eskilsson J, Albertsson M. Failure of preventing 5-fluorouracil cardiotoxicity by prophylactic treatment with verapamil. Acta Oncol 1990; 29:1001-3. [PMID: 2278719 DOI: 10.3109/02841869009091790] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The most common cardiotoxic effects of 5-fluorouracil (5-FU) are chest pain and ischemic ECG abnormalities. Coronary vasospasm may be the underlying mechanism. If so, prophylactic treatment with calcium channel blockers might have a beneficial effect. In the present study, prophylaxis with verapamil (120 mg three times daily) was given to 58 patients with esophageal or advanced head and neck carcinoma during induction chemotherapy with cisplatin and continuous infusion with 5-FU. Signs of ischemia appeared in 12% of the patients as compared to 13% in a previously studied compatible group of patients not receiving prophylaxis. The study does not support the hypothesis that prophylactic treatment with verapamil reduces the incidence of ischemia in patients undergoing 5-FU treatment. Verapamil might, however, modify the adverse cardiac effects of 5-FU by preventing supraventricular tachyarrhythmia.
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Affiliation(s)
- J Eskilsson
- Department of Cardiology, University Hospital, Lund, Sweden
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165
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Affiliation(s)
- G R McKendall
- Department of Medicine, Rhode Island Hospital, Providence 02903
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166
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Thyss A, Milano G, Schneider M, Demard F. Circulating drug levels in patients presenting cardiotoxicity to 5-FU. EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY 1988; 24:1675-6. [PMID: 3208811 DOI: 10.1016/0277-5379(88)90062-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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167
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Affiliation(s)
- S Chaudary
- San Diego Cardiac Center, Sharp Memorial Hospital, University of California
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168
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Eskilsson J, Albertsson M, Mercke C. Adverse cardiac effects during induction chemotherapy treatment with cis-platin and 5-fluorouracil. Radiother Oncol 1988; 13:41-6. [PMID: 3187073 DOI: 10.1016/0167-8140(88)90296-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Survival for patients with advanced head and neck carcinoma and esophageal carcinoma is poor with radiotherapy and/or surgery. Obviously, there is a need for effective chemotherapy. In the present study, cis-platin (80-120 mg/m2BSA) and 5-FU (1000 mg/m2BSA daily as a continuous infusion during 5 days) were given to 76 patients before radiotherapy and surgery. The aim of the study was to clarify the incidence and severity of adverse cardiac effects to this treatment. Before treatment all patients had a cardiac evaluation and during treatment serial ECG recordings were performed. In the pre-treatment evaluation, signs of cardiovascular disease were found in 33 patients (43%). During treatment, adverse cardiac effects were observed in 14 patients (18%). The mean age of these patients was the same as for the entire group, 64 years. The incidence of cardiotoxicity was not higher in patients with signs of cardiovascular disease than in those without in the pre-treatment evaluation. The most common signs of cardiotoxicity were chest pain, ST-T wave changes and atrial fibrillation. This was followed by ventricular fibrillation in one patient and sudden death in another. It is concluded that patients on 5-FU treatment should be under close supervision and that the treatment should be discontinued if chest pain or tachyarrhythmia is observed.
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Affiliation(s)
- J Eskilsson
- Department of Cardiology, University Hospital, Lund, Sweden
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169
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Millward MJ, Ganju V, Buck M. Cardiac arrest--a manifestation of 5-fluorouracil cardiotoxicity. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1988; 18:693-5. [PMID: 3245824 DOI: 10.1111/j.1445-5994.1988.tb00153.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We report a case of cardiac arrest occurring during an infusion of 5-fluorouracil where electrocardiograms suggested coronary artery spasm as the underlying event. Treatment with vasodilators and diltiazem, proved effective. This clinical presentation of 5-fluorouracil cardiotoxicity has not previously been described.
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Affiliation(s)
- M J Millward
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA
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170
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Abstract
Cardiac symptoms, including hypotension, developed in three patients with advanced colorectal carcinoma while being treated with cisplatin (CDDP) and 5-fluorouracil (5-FU). In two patients, hypotension was associated with severe left ventricular dysfunction. All three patients required therapy discontinuation. Cardiac enzymes remained normal despite transient electrocardiographic (EKG) changes. The presentation and cardiac evaluation (hemodynamic, echocardiographic, and scintigraphic) of these patients suggest new manifestations of 5-FU cardiotoxicity that may be influenced by CDDP. The possible pathophysiologic mechanisms are discussed.
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Affiliation(s)
- A A Jakubowski
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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171
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Coronel B, Madonna O, Mercatello A, Caillette A, Moskovtchenko JF. Myocardiotoxicity of 5 fluorouracil. Intensive Care Med 1988; 14:429-30. [PMID: 3403776 DOI: 10.1007/bf00262901] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report a case of specific myocardiotoxicity due to 5 F.U. not previously described in man. A 41-year-old man was admitted to the ICU for heart and renal failure, appearing 24 h after 5 days treatment with 5 F.U. and cis-platinum. Dopamine was necessary to maintain blood pressure. Two-D echocardiography and a right heart catheterisation confirmed the alteration of myocardial contractility. After 2 weeks a complete cardiac recovery occurred.
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Affiliation(s)
- B Coronel
- Département de Néphrologie, Hôpital Edouard Herriot, Lyon, France
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172
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Abstract
Cardiotoxicity manifested as myocardial ischemia is not generally recognized as a side effect of 5-fluorouracil. However, there have been at least 35 cases reported since 1975. In only one of these cases was a somewhat detailed evaluation done to rule out underlying coronary disease. The case reported here of 5-FU cardiotoxicity included an extensive cardiac evaluation to rule out underlying coronary disease and to assess spasm. The literature on 5-FU cardiotoxicity is also reviewed, and its possible mechanisms are analyzed.
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Affiliation(s)
- N J Freeman
- Division of Medical Oncology, University of Massachusetts Medical School, Worcester 01605
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173
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Murthy AK, Taylor SG, Showel J, Caldarelli DD, Hutchinson JC, Holinger LD, Witt TR, Hoover S. Treatment of advanced head and neck cancer with concomitant radiation and chemotherapy. Int J Radiat Oncol Biol Phys 1987; 13:1807-13. [PMID: 3679917 DOI: 10.1016/0360-3016(87)90345-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Forty-four patients with predominantly inoperable or recurrent head and neck cancers were treated with combined chemotherapy (CT) and radiation therapy (RT) in a Phase I/II study. CT and RT were combined in a concomitant fashion to take advantage of radiosensitizing properties of the chemotherapeutic agents. Each treatment cycle consisted of cisplatin 60 mg/M2 on day 1, 5-FU infusion at a dose of 800 mg/M2 per day continuously for 5 days and RT at 200 cGy per day, days 1 through 5. The treatment cycle was repeated every 2 weeks for 7 cycles in patients treated curatively and for 2 to 6 cycles in patients treated palliatively due to prior radiation therapy or the presence of metastatic disease. Regional control was achieved in 98% of the patients. Regional control has persisted in 87% of the patients treated curatively with a minimum follow-up of 24 months. Distant failure occurred in 23% of this group. Actuarial survival of 2 years for the curative group is 66%. Concomitant combination of radiation with radiation potentiating chemotherapeutic agents shows promise of increase in local control.
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Affiliation(s)
- A K Murthy
- Department of Therapeutic Radiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612
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174
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Patel B, Kloner RA, Ensley J, Al-Sarraf M, Kish J, Wynne J. 5-Fluorouracil cardiotoxicity: left ventricular dysfunction and effect of coronary vasodilators. Am J Med Sci 1987; 294:238-43. [PMID: 3661619 DOI: 10.1097/00000441-198710000-00004] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Seven patients developed clinical features simulating myocardial ischemia less than 72 hours after 12 of 13 separate intravenous 5-fluorouracil administrations; 9 episodes were associated with chest pain, 3 with hypotension, 3 with ventricular tachycardia and 1 with cardiogenic shock. Left ventricular dysfunction was demonstrated by echocardiography in 5 separate episodes, 2 with interval improvement upon repeat echocardiograms. Pretreatment with nitrates and/or calcium channel blockers failed to prevent recurrence of cardiotoxicity during 5 of 6 repeat 5-fluorouracil administrations. Therapy with 5-fluorouracil is associated with cardiotoxicity simulating myocardial ischemia with left ventricular dysfunction. Pretreatment with coronary vasodilators may not prevent this phenomenon.
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Affiliation(s)
- B Patel
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
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175
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176
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Abstract
Variant angina developed during intravenous 5-fluorouracil therapy in a patient without prior history of angina pectoris. Ambulatory electrocardiography demonstrated S-T segment elevation and ventricular ectopy during pain, whereas no symptoms or S-T segment changes occurred during placebo therapy. Prophylaxis with both nifedipine and diltiazem was successful in preventing recurrence. It is believed that 5-fluorouracil induced coronary vasospasm and that this was prevented by prophylactic calcium antagonist therapy. Drug-induced coronary artery spasm may be the cause of 5-fluorouracil-associated chest pain.
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177
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Taylor SG, Trybula M, Bonomi PD, Faber LP, Lee MS, Reddy S, Maffey SC, Mathisen DJ, Jensik RJ, Kittle CF. Simultaneous cisplatin fluorouracil infusion and radiation followed by surgical resection in regionally localized stage III, non-small cell lung cancer. Ann Thorac Surg 1987; 43:87-91. [PMID: 3026263 DOI: 10.1016/s0003-4975(10)60173-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sixty-four patients with stage III (M omicron) non-small cell lung cancer were treated with cisplatin fluorouracil infusion chemotherapy and simultaneous radiation therapy for 5 days every other week. A total of 4 cycles (40 Gy) was followed by attempted surgical resection. Clinical response to the preoperative treatment included 5 (8%) complete and 32 (48%) partial responses. Thirty-nine (61%) underwent the planned operation, and in 9 (23%) of these patients the resected specimens were histologically negative. Clinical assessment failed to predict histological response. With 17 months median follow-up (range, 2.4-29 months), estimated 1-year survival was 61% and median survival was 16 months for all patients.
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