| Popis: |
Neuroblastoma is a cancer of the sympathetic nervous system, which accounts for 7% of all childhood cancers and 15% of childhood cancer deaths. During the diagnosis and treatment of these pediatric cancers, children have a high-risk of developing cardiotoxicity due to chemotherapy and perioperative decompensation of this heart disease. The management of side effects mainly involves screening for risk situations based on clinical examination, ECG and echocardiography, mainly preoperatively. The main objective of this study was the cardiac assessment of patients scheduled for neuroblastoma excisional surgery who are on neoadjuvant chemotherapy. Our sample was 20 patients. Average age was 3 years (13 months–6 years) with male predominance, the sex ratio M/F is 1.4. The abdominal seat represented 70% (14 cases) of all locations, the thoracic seat represented 20% (4 cases) of the locations, the pelvic seat represented 10% of the locations. Sixty percent of neuroblastomas were metastatic at the time of diagnosis. Spinal cord infiltration accounted for 60% of all metastatic cases. All of our patients were receiving an anthracycline as part of their chemotherapy regimen, which caused heart damage. The pre-anesthetic clinical examination assessed dyspnea according to the NYHA (New York Heart Association) class. NYHA class I dyspnea was found in 15 patients (75%) of patients. NYHA class II dyspnea was found in 4 patients (20%) of the patients. NYHA class III dyspnea was found in one patient (5%) of patients with pulmonary metastases. NYHA stage IV dyspnea has not been found in any patient. In our study, 40% of cases or 8 patients retained their cardiac function under anthracyclines, 50% or 10 patients developed a moderate to slight decrease in cardiac function. Two patients or 10% of cases developed severe cardiotoxicity with one case of symptomatic cardiac involvement and one case of asymptomatic cardiac involvement. This required a discontinuation of treatment and hospitalization in intensive care in a picture of cardiomyopathy. The two patients with impaired systolic function were put on an Angiotensin-converting enzyme inhibitor. We observed regression of dyspnea and signs of heart disease with improvement in left ventricular ejection fraction. There have been no deaths from heart failure. We changed the chemotherapy protocol with stopping the anthracyclines. We advocated careful ultrasound monitoring for patients with mild to moderate cardiotoxicity. The diagnosis of cardiovascular complications associated with chemotherapy must be early. Cardiopulmonary complications are the third leading cause of death after primary cancer recurrence and the onset of a second cancer. |
Full Text from ScienceDirect