cardiovascular-agents and Hodgkin-Disease

The aim of this article is to review (based on the literature data) the mechanism of chemotherapy- and radiation-induced cardiac toxicity, diagnostic procedures and methods of reducing this toxicity. Cardiac toxicity associated with chemotherapy and radiotherapy may be life threatening, can limit the dose and duration of the treatment and certainly adversely affect short-term and long-term quality of life. A development of new strategies for reduction and prophylaxis of cardiac toxicity has great clinical impact. Chemotherapeutic agents may cause acute myocardial injury or chronic complications (e.g. congestive heart failure). Among cardiotoxic agents anthracyclines cause most serious cumulative, dose-limiting and dose-related cardiomyopathy. Most of them are subclinical changes, however studies demonstrate that symptomatic congestive heart failure in 6-10% of adults who received a cumulative, bolus doses of 550 mg/m2. The frequency of cardiomyopathy may be reduced by modifying the schedule of administration, patients selection considering risk factors, careful cardiac monitoring during chemotherapy, using less toxic doxorubicin analogues and liposomal formulation. The use of pharmacological protection with dexrazoxane remains controversial. A substantial risk of cardiotoxicity may be associated with radiotherapy of the chest and mediastinum. Moreover, radiotherapy may have an additive affect to chemotherapy-induced toxicity. However, with the use of modern treatment techniques radiation cardiomyopathy is uncommon. A group of patients at risk of cardiac complication are patients with breast cancer, Hodgkin's and non-Hodgkin's lymphomas and soft tissue sarcomas.

Topics: Antibiotics, Antineoplastic; Breast Neoplasms; Cardiomyopathy, Dilated; Cardiovascular Agents; Dose-Response Relationship, Drug; Dose-Response Relationship, Radiation; Female; Hodgkin Disease; Humans; Lymphoma, Non-Hodgkin; Neoplasms; Radiotherapy, Adjuvant; Razoxane; Risk Factors; Sarcoma

Topics: Adrenal Cortex Hormones; Antineoplastic Agents; Cardiovascular Agents; Hodgkin Disease; Humans; Leukemia; Neoplasms

Doxorubicin is one of the most effective anticancer drug, but its usefulness is limited by the risk of developing cardiomyopathy, cardiac dysfunction and ventricular arrhythmias. Dexrazoxane is used to protect against doxorubicin cardiotoxicity. It is uncertain whether the dexrazoxane-mediated cardioprotective effect will be reflected in electrophysiological properties of the heart. The aim of the present study was to evaluate the occurrence of frequency-domain signal-averaged electrocardiographic (SAECG) abnormalities of the QRS complex and the initial ST segment in patients treated with and without dexrazoxane. Thirty children and young adults 2 months - 15 years after completion of doxorubicin-containing therapy for Hodgkin's disease were evaluated with SAECG. Patients from group I (n = 13) received combined therapy with doxorubicin and dexrazoxane (DOX/DZX), patients from group II (n = 17) received doxorubicin without dexrazoxane (DOX). Using fast Fourier transformation within the QRS complex and the initial ST segment, area ratio (AR) values 40-100/0-40 Hz were calculated. Significant differences in these frequency parameters in the QRS complex between DOX/DZX group and DOX group (19.45+/-12.72 vs 46.18+/-43.06; p = 0.03) might indicate protective effect of dexrazoxane on electrophysiological myocardial properties.

Topics: Adolescent; Antineoplastic Agents; Arrhythmias, Cardiac; Cardiomyopathies; Cardiovascular Agents; Child; Child, Preschool; Combined Modality Therapy; Doxorubicin; Electrocardiography; Female; Fourier Analysis; Hodgkin Disease; Humans; Infant; Male; Razoxane

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Cardiovascular Agents; Dermatologic Agents; Glucocorticoids; Granuloma; Hodgkin Disease