CARDIOTOXICITY OF HIGH-DOSE-RATE EPIRUBICIN EVALUATED BY ANGIOCARDIOSCINTIGRAPHY

Cardiotoxicity of high dose rate epirubicin (140-160 mg/m(2) as a bolu s every 21 days up to a cumulative dose of 1280 mg/m(2)) was evaluated by angiocardioscintigraphy in 121 patients with advanced neoplastic d isease and no preexisting cardiac risk factors. LVEF was measured in e ach patient before chemotherapy and during the treatment at different epirubicin cumulative dosages. The cases were subdivided into 3 groups : Group A=121 basal studies; Group B=93 studies performed under 800 mg /m(2); Group C=44 studies performed over 800 mg/m(2). A statistically significant decrease of LVEF was observed only at cumulative doses ove r 800 mg/m(2) (mean LVEF: 53% +/- 11% in Group C vs 64% +/- 7% in Grou p A). In no case was chemotherapy stopped prematurely and no case of h eart failure was observed. A decrease of LVEF 10 units was recorded in 15 patients and 12 of them had been treated with over 800 mg/m(2). No clinical signs of severe cardiac failure were observed in these patie nts during a follow-up of 5-17 months. In conclusion, epirubicin treat ment at high dose rate up to a cumulative dose of 1000 mg/m(2) does no t increase the risk of clinically relevant cardiomyopathy and an LVEF decrease of 10 units should not in itself lead to chemotherapy termina tion in responsive patients.