Background:
Anthracycline-induced cardiotoxicity (AIC) limits anthracycline use and causes substantial morbidity and mortality . The prevention of AIC is important in children who can be for decades after being cured of their malignancy
Aim:
To determine the incidence and study the risk factors for development of late anthracycline induced cardiotoxicity in childhood cancer survivors.
Methods:
This is an analysis of prospectively collected data from 2004-14. Childhood cancer survivors registered at the After Completion of Treatment clinic (ACT) at the hospital who have received anthracyclines are included in the study . Demographic and treatment details were recorded. We studied the relation of gender, age at diagnosis of cancer ,cumulative dose of anthracycline, other chemotherapeutic drugs , mediastinal radiotherapy and length of follow-up with development of left ventricular systolic function.Cardiac function was assessed by 2DEchocardiography . Multivariate logistic regression analysis of predictor variables was done.
. Results:
459 patients were included in the study, Males were predominant,350 (76.3%). The median dose of anthracyclines was 300mg/m2 (range 37-827mg/m2). The median duration of follow up was 9.8 years (range 1.7-28 years). 6.8%(31/459) patients developed cardiotoxicity. The median duration from completion of therapy to development of cardiotoxicity was 8.23 years (1.73-21 years). Doxorubicin dose more than 300 mg/m2 , longer duration of follow-up and vincristine based chemotherapy significantly increases CMP risk (p <0.01). Most patients had grade I cardiotoxicity (82%) and were asymptomatic
.Conclusions:
.Doxorubicin dose more than 300mg/m2 and combination treatment with vincristine showed an increase in the risk of cardiotoxicity. As the risk of cardiotoxicity increases with longer duration of follow up, regular cardiac monitoring is advocated in all childhood cancer survivors who have received anthracyclines . Most patients have subclinical cardiotoxicity .The long term implications of subclinical cardiotoxicity needs to be studied.