High incidence of adriamycin cardiotoxicity in children even at low cumulative doses: Role of radionuclide cardiac angiography

Abstract

Background/Purpose: Adriamycin (doxorubicin), a chemotherapeutic agent commonly used in the treatment of pediatric solid tumors, is known to have a dose-related cardiotoxicity, which is reported to be more common in children. The clinical manifestation of this is congestive cardiac failure (CHF), and this is fatal in 50% of the cases. Various strategies, including prospective multiple gated acquisition (MUGA) scan for early detection of the onset of cardiac damage has been recommended to decrease this fatality caused by cardiotoxicity. Methods: All children receiving Adriamycin for solid tumors, registered at our pediatric solid tumor clinic from January 1998 through June 1999, were included in the study. Cardiotoxicity was evaluated by using electrocardiogram (ECG)-gated radionuclide cardiac angiography (MUGA scan). Results: MUGA scans were performed on 55 patients in the above-mentioned period of 18 months. Twenty-three patients had only 1 baseline MUGA scan done, 12 of these are awaiting further studies at appropriate time and 11 are either dead or lost to follow-up. Of the remaining 32 patients, 13 have shown evidence of cardiotoxicity on MUGA scan done at a cumulative dose of 180 to 200 mg/m2, in the form of decrease in left ventricular ejection fraction (LVEF) or abnormality in myocardial movements. Three of these 13 patients had clinical evidence of CHF. In 10 patients, timely discontinuation of Adriamycin, based on the MUGA report, probably has helped avoid the development of CHF. Conclusion: Routine monitoring of all children receiving Adriamycin is required to avoid the mortality and morbidity of Adriamycin-related cardiotoxicity, which may develop at relatively low cumulative doses also. J Pediatr Surg 35:1786-1789. Copyright © 2000 by W.B. Saunders Company.