[Evaluation of cardiotoxicity by radionuclide angiocardiography in the chemotherapy of gynecologic malignancies].

Abstract

Cardiotoxicity was evaluated by multigated radionuclide angiocardiography using in vivo 99mTc labeling of red blood cells in the multiagent chemotherapies of gynecologic malignancies. The left ventricular ejection fraction (LVEF) was determined by computer-assisted analysis of left ventricle time activity curves (TAC) of the angiocardiograms. The mean age of fifteen patients was 52.3 (38-66) years. Ovarian carcinoma (13 patients), the endometrial carcinoma (one) and uterine leiomyosarcoma (one) were treated with a total of 69 combination chemotherapy of CAP every 4 weeks. Fifteen patients underwent a total of 76 quantitative radionuclide angiocardiograms (three to seven studies per patient). The values of LVEF before treatment were 57.5 +/- 8.3 (mean +/- SD) (48.7-75.4), which were greater than those of normal persons (45). The values of LVEF during treatment were 44.9 +/- 6.2 (mean +/- SD) (37.6-58.5), which were significantly (p less than 0.001) lower than the pretreatment values. The decrease rates of LVEF in fifteen patients were 21.0 +/- 10.4% (mean +/- SD). Over 20% decrease of LVEF was observed in eight patients (53.3%) following chemotherapies. The patients showing a decrease of the values of LVEF were treated with lower dosage of chemotherapeutic agents in three, changed in seven and discontinued in six the agents. Nine patients who changed the chemotherapeutic regimens showed improvement of the values of LVEF in six (66.7%), no change in two (22.2%) and deterioration in one (11.1%). The values of LVEF were decreased in four patients (44.4%) at 6.7 (3-11) months following chemotherapies. It is suggested from these findings that the determination of left ventricular ejection fraction using multigated radionuclide angiocardiography may prevent development of cardiotoxicity before, during and after the chemotherapies of gynecologic malignancies and allow a clinically important assessment of the cardiotoxicity of the chemotherapeutic agents.