Adriamycin and epirubicin treatment monitored by radionuclide ejection fraction during therapy and follow-up.

Abstract

Twenty-four patients with advanced breast cancer were studied with serial determinations of the radionuclide ejection fraction at rest (RST-LVEF) during anthracycline chemotherapy (CT) and with a mean follow-up (FU) of 8 months. We had 2 cases of anthracycline congestive heart failure (CHF) during FU, 3 and 12 months respectively after the end of CT. The RST-LVEF changes observed during CT were not able to predict which patients were to develop a symptomatic cardiomyopathy. The type of RST-LVEF change that is generally considered a worsening of cardiac performance is a decline greater than or equal to 15%. We had this type of RST-LVEF change, in addition to the 2 CHF, in 5 other patients without symptomatic cardiomyopathy. Nevertheless none of these 5 patients attained pathological values of RST-LVEF, while the 2 CHF showed symptomatic cardiomyopathy only when RST-LVEF became clearly pathologic (less than or equal to 46%). Therefore, although in our study the RST-LVEF changes during CT did not have predictive value for CHF, the method may give a notable clinical contribution all the same. In fact, by submitting the patients with a RST-LVEF fall greater than or equal to 15% to frequent sequential RST-LVEF determinations and stopping the CT if the RST-LVEF becomes pathologic it is possible to avoid severe and irreversible CHF.