Clinical Oncology Letters
http://www.col.periodikos.com.br/article/doi/10.4322/col.2018.002
Clinical Oncology Letters
Artigo Original

Avaliação da Cardiotoxicidade induzida por Quimioterapia em pacientes com Câncer de Mama

Evaluation of Chemotherapy-induced Cardiotoxicity in Breast Cancer patients

Igor Luiz Argani; Camila Arruda; Jean Schoueri; Mirella Scaff; Fernando Kaufman; Juliana Canonaco; João Vitor Teixeira; Claudia Sette; Daniel Cubero; Auro del Giglio

Downloads: 4
Views: 201

Resumo

Objetivo: Avaliar a alteração da função cardíaca em pacientes com câncer de mama tratadas com quimioterapia. Métodos: Estudo observacional retrospectivo com coleta de dados em prontuário no Hospital Mário Covas (Santo André – Brasil). Avaliou-se a fração de ejeção obtida pelo ecocardiograma (ECO) antes do tratamento quimioterápico, em comparação com o ECO ao final do tratamento. Resultados: Foram incluídas 234 pacientes com câncer de mama submetidas a QT, das quais 100 realizaram ao menos um ECO e 33, pelo menos dois exames. Desse total, apenas 18 puderam ser analisados, pois apresentavam ECO feito corretamente, i.e., antes e depois do tratamento quimioterápico. Analisando esses ECOs, observou-se diferença da fração de ejeção média de 5% (IC95% 2,9-7,6; p=0,0001). Conclusão: A alta prevalência e o expressivo aumento da sobrevida de pacientes com câncer de mama indicam a necessidade de acompanhamento adequado dos efeitos a longo prazo da QT. A análise dos ECO feitos adequadamente nos pacientes com câncer de mama nesse estudo demonstrou significante queda da fração de ejeção, confirmando os efeitos cardiotóxicos da QT. Apesar disso, apenas uma fração pouco expressiva dos pacientes apresentou acompanhamento adequado.

Palavras-chave

Câncer de Mama, Cardiotoxicidade, Saúde Pública

Abstract

Objective: Evaluate the alteration of cardiac function in breast cancer patients treated with chemotherapy. Methods: Retrospective observational study with data collection in medical records at Hospital Mário Covas (Santo André - Brazil). The ejection fraction obtained by the echocardiogram (ECO) before the chemotherapy treatment was evaluated, in comparison with the ECO at the end of the treatment. Results: 234 breast cancer patients undergoing chemotherapy were included, of whom 100 performed at least one ECO and 33 at least two exams. Of this total, only 18 could be analyzed, since they had ECO done correctly, i.e., before and after the chemotherapy treatment. Analyzing these ECOs, we observed a difference of the mean ejection fraction of 5% (95% CI 2.9-7.6, p = 0.0001). Conclusion: The high prevalence and significant increase in survival of breast cancer patients indicate the need for adequate follow-up of the long-term effects of QT. The analysis of echocardiogram performed adequately in patients with breast cancer in this study demonstrated a significant decrease in ejection fraction, confirming the cardiotoxic effects of chemotherapy. Despite this, only a small fraction of the patients presented adequate follow-up

Keywords

Breast cancer; Cardiotoxicity; Public Health

Referências

1. Brasil. Ministério da Saúde. Estimativas da incidência e mortalidade por câncer no Brasil [Internet]. Rio de Janeiro: Instituto Nacional de Câncer; 2016 [citado 2016 nov 3]. Disponível em: http://www2.inca.gov.br/wps/wcm/connect/tiposdecancer/site/home/mama

2. Brasil. Ministério da Saúde. Registro hospitalar de câncer – Relatório anual 1994/1998 [Internet]. Rio de Janeiro: Instituto Nacional de Câncer; 2016 [citado 2016 nov 3]. Disponível em: http://www.inca.gov.br/rhc/docs/INCA_94_98.pdf

3. Minami M, Matsumoto S, Horiuchi H. Cardiovascular sideeffects of modern cancer therapy. Circ J. 2010;74(9):1779-86. http://dx.doi.org/10.1253/circj.CJ-10-0632. PMid:20716834.

4. Adão R, Keulenaer G, Leite-Moreira A, Brás-Silva C. Cardiotoxicidade associada à terapêutica oncológica: mecanismos fisiopatológicos e estratégias de prevenção. Rev Port Cardiol. 2013;32(5):395-409. http://dx.doi.org/10.1016/j.repc.2012.11.002. PMid:23623503.

5. Karanth NV, Roy A, Joseph M, Pasquale C, Karapetis C, Koczwara B. Utility of prechemotherapy echocardiographical assessment of cardiac abnormalities. Support Care Cancer. 2011;19(12):2021-6. http://dx.doi.org/10.1007/s00520-010-1054-z. PMid:21120541.

6. Mina A, Rafei H, Khalil M, Hassoun Y, Nasser Z, Tfayli A. Role of baseline echocardiography prior to initiation of anthracycline-based chemotherapy in breast cancer patients. BMC Cancer. 2015;15(1):10. http://dx.doi.org/10.1186/s12885-014-1004-0. PMid:25605569.

7. Kalil R Fo, Hajjar LA, Bacal F, Hoff PM, Diz MP, Galas FRBG. Diretriz brasileira de cardio-oncologia da sociedade brasileira de cardiologia. Arq Bras Cardiol. 2011;96(2 Suppl 1):1-52. http://dx.doi.org/10.1590/S0066- 782X2011000700001.

8. Sá MPBO, Gomes RAF, Silva NPC, Sá MVBO, Calado I Fo. Cardiotoxicity and chemotherapy. Rev Bras Clin Med. 2009;7(5):326-30.

9. Young JL Jr, Roffers SD, Ries LAG, et al., editors. SEER summary staging manual - 2000 codes and coding instructions. Bethesda: National Cancer Institute; 2001 [citado 2016 nov 3]. Disponível em: https://seer.cancer.gov/tools/ssm/ssm2000/SSSM2000-122012.pdf

10. Doyle JJ, Neugut AI, Jacobson JS, Grann VR, Hershman DL. Chemotherapy and cardiotoxicity in older breast cancer patients: a population-based study. J Clin Oncol. 2005;23(34): 8597. PMid:16314622.

11. Seidman A, Hudis C, Pierri MK, et al. Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol. 2002;20(5):1215-21. http://dx.doi.org/10.1200/JCO.2002.20.5.1215. PMid:11870163.

12. Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced cardiotoxicity. Maedica (Buchar). 2013;8(1):59-67. PMid:24023601.

13. Dolci A, Dominici R, Cardinale D, Sandri MT, Panteghini M. Biochemical markers for prediction of chemotherapyinduced cardiotoxicity: systematic review of the literature and recommendations for use. Am J Clin Pathol. 2008;130(5):688-95. http://dx.doi.org/10.1309/AJCPB66LRIIVMQDR. PMid:18854260.

14. Fiúza M. Cardiotoxicity associated with trastuzumab treatment of HER2+ breast cancer. Adv Ther. 2009;26(Suppl 1):9-17. http://dx.doi.org/10.1007/s12325-009-0048-z. PMid:19669637.

15. Onitilo AA, Engel JM, Stankowski RV. Cardiovascular toxicity associated with adjuvant trastuzumab therapy: prevalence, patient characteristics, and risk factors. Ther Adv Drug Saf. 2014;5(4):154-166. http://dx.doi.org/10.1177/2042098614529603.

16. Gianni L, Salvatorelli E, Minotti G. Anthracycline cardiotoxicity in breast cancer patients: synergism with trastuzumab and taxanes. Cardiovasc Toxicol. 2007;7(2):67-71. http://dx.doi.org/10.1007/s12012-007-0013-5. PMid:17652806.

17. Sawaya H, Sebag IA, Plana JC, et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circ Cardiovasc Imaging. 2012;5(5):596-603. http://dx.doi.org/10.1161/CIRCIMAGING.112.973321. PMid:22744937.

18. Spedo SM, Pinto NRS, Tanaka OY. O difícil acesso a serviços de média complexidade do SUS: o caso da cidade de São Paulo, Brasil. Physis. 2010;20(3):953-72. http://dx.doi.org/10.1590/S0103-73312010000300014.

19. Dores H, Abecasis J, Correia MJ, et al. Detection of early sub-clinical trastuzumab-induced cardiotoxicity in breast cancer patients. Arq Bras Cardiol. 2013;100(4):328-32. PMid:23525273.

20. Albini A, Pennesi G, Donatelli F, Cammarota R, Flora S, Noonan DM. Cardiotoxicity of Anticancer Drugs: The Need for Cardio-Oncology and Cardio-Oncological Prevention. JNCI Journal of the National Cancer Institute. 2010;102(1):1-11. http://dx.doi.org/10.1093/jnci/djp440. PMid:20007921.

5cdafaee0e8825fb5686c887 col Articles
Links & Downloads

Clin Onc Let

Share this page
Page Sections