Perfil cardiológico de pacientes oncológicos pediátricos tratados com antraciclinas

Abstract

Introduction: The incorporation of chemotherapeutics in the treatment of childhood and adolescent cancer, especially after the use of anthracyclines, considerably provided an increase in the survival of these patients, but, at the same time, there was a considerable increase in early morbidity and mortality due to the side effects provoked by these medications on the cardiovascular system, especially those related to the ventricular function. Objectives: To identify the incidence of cardiovascular complications and risk factors associated to treatment with anthracyclines in pediatric cancer patients. Method: This is study corresponds to a retrospective cohort carried out through research and data collection in physical and / or electronic medical records. Patients of both genders who were excluded, were aged up to 19, had neoplastic disease treated with anthracyclines with treatment beginning between 2014 and 2018 and whose completion had been by April 10, 2020 making a total of 118 (26.57%) patients being excluded with incomplete information in the medical record and migration to another center. Cardiovascular complications were divided into G1 (General) and G2 (related to ventricular dysfunction). Result: During the study period, 826 patients were admitted, of which 53.75% (n=444) had a therapeutic indication for the use of anthracyclines. Of these, 73.42% (n = 326) were included and 26.57% (n=118) were excluded from the analysis. The average age at diagnosis was 6.85, with a standard deviation of 5.03 out of which 58.90% (n=192) were male. There was a prevalence of leukemias in 51.23% (n = 167). G1 cardiovascular complications occurred in 141 of the patients (43.25%), with SAH being the most prevalent in 15,33% (n=50). Cardiovascular complications of G2 occurred in 25.76% of the patients (n = 84). Diuretics were the most widely prescribed cardiological drugs in 34.66% of the patients (n = 113). Age (p=0.070), female (p=0.694), cumulative dose (CD) greater than 250mg/m2 (p=0.305), and association with other cardiotoxic drugs (ifosfamide and cyclophosphamide) and (p=0.051) and mediastinal radiotherapy (p=0.566) showed no significant association with CV complications in G2. The types of tumors were: leukemias 51.23% (n=167), lymphomas 17.48% (n=57), kidney tumors 7.36% (n=24), Sarcomas 7.36% (n=24) , neuroblastomas 6.75% (n=22), osteosarcomas 6.44% (n=21), liver tumors 2.15% (n=7) and other tumors 1.23% (n=4). Dexrazoxane was used in 73 patients (22; 39%), of these, G2 complications occurred in 18 (24.6%). Of those who did not use this medication, G2 complications occurred in 66 patients (26.08%), respectively, the use of Dexzaroxane did not show statistical significance for cardioprotection (Risk of Chance = 1.078 and [95%=Confidence Interval = 0.591-1.968], p=0.806). Regarding the cardiac evaluation, of the 326 patients 2.45% (n=8) did not undergo echocardiography and of those who underwent 97.54% (n=318) in 77.35% (n=246) the first echocardiogram was performed before the first dose of anthracyclines. In the association of CV complications with age, congestive heart failure with the use of vasoactive drugs was associated with patients under 4 years of age and with left ventricular systolic dysfunction in children over 10 years of age. Deaths occurred in 27.91% (n=91) of patients; of these, 57.14% (n=52) were male, and the most prevalent cause of death was the recurrence and/or progression of the disease in 62.63% (n=57) due to cardiovascular causes occurred in 5.49% (n=5). Conclusion: In the study, general cardiovascular complications were more frequent. They occurred in 43,25% (n=141) of patients compared to changes in ventricular function that occurred in 25.76% (n=84) of patients, denoting the need for these forms of presentation of cardiotoxicity to also be included in the planning of monitoring and prevention strategies. The study reinforces the understanding that there is no safe dose of anthracyclines, since 73.31% (n=239) of the patients used anthracycline doses <250mg/m2 and even so, these complications occurred in 1 out of 4 patients.