Abstract
Background. Childhood cancer survivors treated with anthracyclines and mediastinal irradiation are at risk for late onset cardiotoxicity. Aims of the Study. To assess the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) as early predictors of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin with or without mediastinal irradiation. Methods. A cross-sectional study on 58 asymptomatic survivors of childhood cancer who received doxorubicin in their treatment protocols and 32 asymptomatic Hodgkin's lymphoma survivors who received anthracycline and mediastinal irradiation. Levels of NT-proBNP, TDI, and conventional echocardiography were determined. Results. Thirty percent of survivors had abnormal NT-proBNP levels. It was significantly related to age at diagnosis, duration of follow-up, and cumulative dose of doxorubicin. TDI detected myocardial affection in 20% more than conventional echocardiography. Furthermore, abnormalities in TDI and NT-pro-BNP levels were more common in Hodgkin lymphoma survivors receiving both chemotherapy and radiotherapy. Conclusions. TDI could detect early cardiac dysfunction even in those with normal conventional echocardiography. Measurement of NT-proBNP represents an interesting strategy for detecting subclinical cardiotoxicity. We recommend prospective and multicenter studies to validate the role of NT-proBNP as an early marker for late onset doxorubicin-induced cardiotoxicity.
Highlights
Anthracyclines are widely used antineoplastic agents for the treatment of both childhood hematological malignancies and solid tumors, including acute lymphoblastic leukemia (ALL), acute myeloid leukemia, non-Hodgkin and Hodgkin’s lymphoma, neuroblastoma, osteosarcoma, Ewing tumors, and nephroblastoma
This study aimed to assess the role of N-terminal probrain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) as early predictors of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin with or without mediastinal irradiation
The early identification of patients at risk for cardiotoxicity is a primary goal for both cardiologists and oncologists, allowing for the planning of personalized antineoplastic therapeutic strategies, the support of cardiac function, and the monitoring of the progression of cardiac damage [16]
Summary
Anthracyclines are widely used antineoplastic agents for the treatment of both childhood hematological malignancies and solid tumors, including acute lymphoblastic leukemia (ALL), acute myeloid leukemia, non-Hodgkin and Hodgkin’s lymphoma, neuroblastoma, osteosarcoma, Ewing tumors, and nephroblastoma. And accurate diagnosis of ventricular dysfunction in asymptomatic cardiac patients may permit a prompt onset of therapy of subclinical cardiotoxicity before the development of life-threatening complication [6]. Current monitoring techniques, such as MUGA (multigated acquisition scan) or echocardiography, have substantial limitations and detect LV dysfunction only after it had occurred. Childhood cancer survivors treated with anthracyclines and mediastinal irradiation are at risk for late onset cardiotoxicity. To assess the role of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) as early predictors of late onset cardiotoxicity in asymptomatic survivors of childhood cancer treated with doxorubicin with or without mediastinal irradiation. We recommend prospective and multicenter studies to validate the role of NT-proBNP as an early marker for late onset doxorubicin-induced cardiotoxicity
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