RADIONUCLIDE EJECTION FRACTION IN DOXORUBICIN CARDIOTOXICITY

  • 1 January 1981
    • journal article
    • research article
    • Vol. 65  (7-8) , 629-638
Abstract
Serial assessment of cardiac function by radionuclide ejection fraction (EF), using a 1st-pass technique, was performed prior to each dose in 292 patients receiving doxorubicin. Detailed analysis was undertaken in 98 patients, consisting of all 91 patients who had received > 200 mg/m2 and 7 with risk factors (RF) who had received between 100 and 200 mg/m2. Thirty-two patients had RF and 66 had no risk factors (NRF). RF were: cardiovascular disease, mediastinal irradiation within 6 mo. of starting doxorubicin treatment and total doxorubicin dose > 550 mg/m2. The criteria for discontinuing doxorubicin were EF < 0.40 in RF patients or < 0.35 in NRF patients or decrease in EF of .gtoreq. 0.14 over 3 successive readings. In the NRF group, no patient met these criteria nor did any develop cardiac failure. In the RF group, discontinuation was indicated in 8 patients: 2 stopped receiving doxorubicin at total doses of 730 mg/m2 and 680 mg/m2, respectively and it was discontinued in the other 6 at total doses ranging from 120-420 mg/m2. Prior to the 1st dose of doxorubicin, all patients should have a baseline EF and assessment of RF. An EF study is required before each subsequent dose in patients with RF or with initial EF < 0.45, but in the remaining patients, serial studies are not required until there is a cumulative dose of 450 mg/m2. Use of these guidelines and criteria for discontinuation may prevent development of doxorubicin cardiotoxicity.