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Letter to the editor

Editor, – In the interest of semantic accuracy, I do not believe the answer to question 12 in the self-test questions is correct in 'Complications of cytotoxic therapy - part 2' (Aust Prescr 1995;18:105-7).

The cardiotoxicity of doxorubicin is not increased in patients having concomitant radiotherapy to the chest unless that radiation therapy includes the heart in the treatment volume. It is the radiation of the heart per se,not irradiation of the chest, which is dangerous.

A.O. Langlands
Division of Radiation Oncology
Westmead Hospital
Westmead, N.S.W.

Author's comments

Dr A. Bonaventura, the author of the article, comments:

Professor Langlands' semantics are correct. Irradiation of major portions of the heart potentiates the development of adriamycin-induced cardiomyopathy. This can occur during treatment of patients with carcinoma of the lung, oesophagus, mediastinal tumours, breast cancer and lymphomas. The combined effects (synergistic) of radiation and adriamycin on the heart result in injury to different target cells (radiation damages the microvasculature and adriamycin the myocytes).

Potential ways of reducing chemoradiation cardiotoxicity include

  • limiting the cumulative adriamycin dose to 400 mg/m2 in patients who have had incidental radiation to the heart
  • continuous infusion of adriamycin
  • use of cardio-protective agents e.g. ICRF-187
  • development of less toxic anthracycline analogues e.g. epirubicin, mitoxantrone
  • modification of radio-therapeutic techniques
  • close monitoring of cardiac function.