The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.


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.

A.O. Langlands

Division of Radiation Oncology, Westmead Hospita,l Westmead, N.S.W.