[Subacute cardiotoxicity caused by anthracycline therapy in children: can dexrazoxane prevent this effect?]

OBJECTIVES

The use of anthracyclines are limited by their cardiotoxic side effects (first of all congestive cardiomyopathy). In this study we analyzed the anthracycline-induced cardiotoxicity and the possible preventive role of dexrazoxane in children.

PATIENTS

158 anthracycline-treated long-term survivors could be analyzed. Sixty-one children received dexrazoxane (group D) and 97 patients received anthracyclines only (group C).

METHODS

Cardiac ultrasound examinations (ECHO) and electrocardiograms (ECG) were performed regularly from the beginning of chemotherapy and yearly thereafter. Shortening fraction (FS) was used as indicator of the ventricular function.

RESULTS

The incidence of reduced left ventricular function (FS) was 13.4% in C, and 8.2% in D (p=ns). Two years after completion of the chemotherapy FS was reduced in 13.7% in C and 0% in D, respectively (p=0.056), and 5 years after therapy in 11.0% in C and 2.4% in D, respectively (P=0.034). Left chamber wall diameter was abnormal in systole in 6% in C and 2% in D, in diastole in 11% in C and 7% in D (p=ns) after 3 years of follow-up.

CONCLUSION

Anthracycline-induced subacute cardiotoxicity can be significantly diminished by the concomitant use of dexrazoxane. For the final conclusions longer follow-up is necessary.

Detection of early ototoxic effect in testicular-cancer patients treated with cisplatin by transiently evoked otoacoustic emission: a pilot study

The outlook for patients with testicular germ cell cancer was dramatically improved by the introduction of cisplatin. Well-known side effects of cisplatin (nausea, vomiting, nephrotoxicity, myelosuppression) can be managed with preventive methods. The long life expectancy after this therapy draws attention to long-term side effects. The ototoxic side effects were scarcely studied, although nowadays, they can be a dose-limiting side effect of cisplatin.

PATIENTS AND METHODS

As the literature shows, the ototoxic side effects of cisplatin have been studied mostly by conventional methods. The authors used transiently evoked otoacoustic emissions to determine whether the administration of 20 mg/m2 body surface cisplatin daily (in combination with other antitumor drugs) for 5 days alters the amplitude of the transient otoacoustic emission.

RESULTS

The results did not show any significant amplitude change after 20 mg/m2 cisplatin daily for 5 days, in contrast with other studies that described a broad frequency reduction of the emission amplitude in 30-86% of cases treated with 100 mg/m2 of cisplatin for 1 day.

CONCLUSION

The authors suggest that between similarly effective regimens, those containing lower daily cisplatin doses should be used.