Kesavan Shan, MD; A. Michael Lincoff, MD; James B. Young, MD
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Shan K, Lincoff AM, Young JB. Anthracycline-Induced Cardiotoxicity. Ann Intern Med. 1997;126:827-828. doi: 10.7326/0003-4819-126-10-199705150-00020
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Published: Ann Intern Med. 1997;126(10):827-828.
We thank Dr. Steinherz for highlighting data on the long-term follow-up of patients after anthracycline treatment. Nevertheless, there remains a concerning lack of prognostic information from adequately powered controlled studies assessing cardiac function in patients more than 10 years after anthracycline therapy. For example, in one of Steinherz and colleagues' reports , no control group was used for comparison; because of the abstract format of the report, few specific clinical details are available on the patients studied. In our review we attempted to concentrate on follow-up studies of anthracycline recipients that were as detailed as possible in order to allow a more considered interpretation of the results. The confounding factors that we mentioned in our conclusion, such as heterogeneity of the study patients and preexisting heart disease, are difficult to dissect in abstracts. Thus, we await the publication of full-length reports of such studies as that of Steinherz and colleagues on the extended follow-up of patients more than a decade after treatment with anthracyclines. The 4 of 20 patients with new-onset ventricular dysfunction whom we mentioned in our review were indeed described by Dr. Steinherz's group in 1991. These researchers' 1993 report  discusses a pilot study that assessed 18 children who received continuous infusion of danorubicin but that lacked concurrent controls. As stated in our review, it is therefore clear that the overall benefit derived from continuous infusion of anthracycline in children in terms of antineoplastic effect versus cardiotoxicity still awaits rigorous proof.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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