CARDIAC-FUNCTION IN WILMS-TUMOR SURVIVORS

Purpose: To study late cardiac function in a single diagnostic group ( children with Wilms' tumor) with good long-term survival; to compare p atients treated with anthracyclines (doxorubicin) with patients treate d without anthracyclines and with a normal child/adolescent group; and to examine the risk factors involved in late cardiac dysfunction. Pat ients and Methods: Echocordiographic studies were performed on 97 Wilm s' tumor patients treated with anthracyclines (mean cumulative dose, 3 03 mg/m(2)) with a mean follow-up time of 7.1 years, on 39 Wilms' tumo r patients treated without anthracyclines with a mean follow-up time o f 8.9 years, and on 50 normal subjects. Left ventricular (LV) dimensio ns, end systolic wall stress (a measure of afterload), and load-depend ent and -independent measures of contractility were compared between g roups. Potential risk factors, including age at diagnosis, follow-up d uration, sex, pubertal status, cardiac irradiation, dose-intensity, an d cumulative dose of anthracyclines, were studied by multivariate anal ysis. Results: Twenty-five percent of the anthracycline-treated group showed cardiac abnormalities. All but one of these patients had increa sed LV afterload. Risk factors for increased afterload were anthracycl ine cumulative dose (P < .05) and anthracycline dose intensity (P < .0 2). Wilms' tumor patients treated without anthracyclines had thickened LV walls compared with normal subjects (P < .05). Conclusion: Total d ose and dose-intensity of anthracycline were risk factors for increase d LV afterload in long-term Wilms' tumor survivors treated on standard protocols. The increase in afterload accounted for reduced LV shorten ing, whereas contractility was rarely abnormal. The new finding that W ilms' tumor survivors who do not receive anthracyclines have mild LV h ypertrophy may provide some protection against anthracycline-induced c ardiotoxic effects. (C) 1995 by American Society of Clinical Oncology.