High incidence of adriamycin cardiotoxicity in children even at low cumulative doses: Role of radionuclide cardiac angiography

Background/Purpose: Adriamycin (doxorubicin), a chemotherapeutic agent comm only used in the treatment of pediatric solid tumors, is known to have a do se-related cardiotoxicity, which is reported to be more common in children. The clinical manifestation of this is congestive cardiac failure (CHF), an d this is fatal in 50% of the cases. Various strategies, including prospect ive multiple gated acquisition (MUGA) scan for early detection of the onset of cardiac damage has been recommended to decrease this fatality caused by cardiotoxicity. Methods: All children receiving Adriamycin for solid tumors, registered at our pediatric solid tumor clinic from January 1998 through June 1999, were included in the study. Cardiotoxicity was evaluated by using electrocardiog ram (ECG)gated radionuclide cardiac angiography (MUGA scan). Results: MUGA scans were performed on 55 patients in the above-mentioned pe riod of 18 months. Twenty-three patients had only 1 baseline MUGA scan done , 12 of these are awaiting further studies at appropriate time and 11 are e ither dead or lost to follow-up. Of the remaining 32 patients, 13 have show n evidence of cardiotoxicity on MUGA scan done at a cumulative dose of 180 to 200 mg/m(2), in the form of decrease in left ventricular ejection fracti on (LVEF) or abnormality in myocardial movements. Three of these 13 patient s had clinical evidence of CHF. In 10 patients, timely discontinuation of A driamycin, based on the MUGA report, probably has helped avoid the developm ent of CHF. Condusion: Routine monitoring of all children receiving Adriamycin is requi red to avoid the mortality and morbidity of Adriamycin-related cardiotoxici ty, which may develop at relatively tow cumulative doses also. J Pediatr Su rg 35:1786-1789. Copyright (C) 2000 by W.B. Saunders Company.