Prospective study of cardiomyopathy induced by adjuvant doxorubicin therapy in patients with soft-tissue sarcomas
S. E. Ettinghausen, R. O. Bonow, S. T. Palmeri, C. A. Seipp, S. M. Steinberg, D. E. White and S. A. Rosenberg
Since a combination of surgery and adjuvant high-dose doxorubicin therapy
can prolong survival in patients with extremity sarcomas, but at the
expense of significant cardiomyopathic changes, we prospectively studied
the differences in cardiotoxicity in 118 patients with sarcomas treated
with high- vs low-dose doxorubicin therapy following surgery. Cardiac
function, as assessed by left ventricular ejection fraction (EF), was
determined by standard radionuclide angiography during rest and exercise.
No patients in this study developed congestive heart failure. While both
regimens produced net decreases in EF during rest and exercise, the
high-dose doxorubicin regimen resulted in significantly greater declines in
EF than the low-dose protocol. Of patients with normal baseline values, a
greater percentage of patients receiving the high-dose regimen developed an
abnormal EF than did those receiving the low-dose regimen, even after
separating younger from older individuals. Thus, treatment-induced
cardiomyopathy appears to be a significant clinical problem after both
high- and low-dose doxorubicin therapy. The use of the low-dose regimen
decreases the magnitude of the cardiomyopathic changes.
