Risk stratification and pattern of cardiotoxicity in pediatric Ewing sarcoma

Abstract

Introduction: Anthracycline chemotherapy contributes to improved outcomes in Ewing sarcoma; however, the most feared complication is cardiotoxicity. Echocardiograms were routinely used to monitor cardiac function after anthracycline treatment. Nevertheless, indices chosen to assess cardiac toxicity vary significantly among different centers, and no uniform protocol has been accepted as ideal. Methods: This retrospective study included children with Ewing sarcoma treated at Children’s Cancer Hospital Egypt over 4 years. All echocardiograms and related clinical assessments were reviewed. Results: In total, 149 patients (median age 11 years; range 1–18 years) were included. Although all patients had a reduced ejection fraction compared with their baseline echocardiogram, only 39 patients developed cardiotoxicity (26%): 43% acute-onset, 36% chronic early-onset, and 21% chronic late-onset. There were no statistically significant association between the frequency of myocardial dysfunction and risk factors, including age, sex, follow-up duration, cumulative doxorubicin dose, and mediastinal irradiation. Over one-third (39%) of the patients with cardiac toxicity regained normal cardiac parameters, whereas seven patients died of acute cardiac toxicity. Conclusion: The routine use of echocardiography to screen for anthracycline-induced cardiac toxicity before and during chemotherapy identified myocardial dysfunction. Early medical intervention can improve cardiac parameters. Improved screening techniques with better sensitivity and predictability are needed.

Keywords

• Late effects
• Anthracyclines
• Cardiotoxicity
• Ewing sarcoma
• Echocardiography