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Early monitoring for anthracycline-related cardiotoxicity has little clinical impact

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Among children receiving anthracycline-based chemotherapy, echocardiograms obtained before and during treatment rarely detect significant cardiotoxicity that changes treatment decisions, reports a team with the University of Alabama at Birmingham.

“Pediatric Oncology cooperative groups should consider a revision of standard monitoring protocols before and during treatment,” they recommend in their paper in Cancer online August 31.

Outcomes of childhood cancers have improved with the use of anthracyclines, but drug-related myocardial damage can occur, note Dr. Raymond G. Watts and colleagues. They point out that the Children’s Oncology Group and other recommend that echocardiograms be obtained before, during and at regular intervals after children have received anthracycline-containing protocols.

The necessity of late cardiac screening has been validated, they explain, but the value of routine echocardiographic studies before and during treatment is unclear. The team therefore conducted a retrospective study of 356 children treated with anthracycline chemotherapy at their cancer center over a 5-year period, for whom 991 echocardiograms were performed.

The investigators identified only 9 abnormal echo results. Four of these results were obtained during episodes of septic shock, two were false positives, and one was a mild abnormality seen after resection of a large Wilms tumor, the report indicates.

None of the 356 pretreatment echocardiograms altered treatment decisions, while two of the echocardiograms obtained during treatment led to a change of plans, Dr. Watts and colleagues found.

They conclude, “Our study suggests that prechemotherapy echocardiography in children does not change the clinical conduct of their chemotherapy regimen and that intra-treatment echocardiogram is likely to change therapy in <1 in 400 patients.”

They say that while guidelines developed in 1992 “have served children well, it is likely time to re-evaluate these guidelines and recommendations.”

Pretreatment and routine echocardiogram monitoring during chemotherapy for anthracycline-induced cardiotoxicity rarely identifies significant cardiac dysfunction or alters treatment decisions
Cancer 2011.