[Electrocardiogram analysis of adriamycin cardiotoxicity in 160 cases]

From January 1986 to May 1989, 160 cancer patients proven by pathology were treated by combined chemotherapy with adriamycin (ADM) as the chief agent. Of them, 20 were given simultaneous cyclophosphamide (CTX) and 14 had received mediastinal irradiation. 40 mg/m2 of ADM was given by rapid IV bolus injection which was repeated every 3 weeks. All but 9 had normal electrocardiogram (ECG) before ADM administration. In these 9 patients, when ADM reached certain accumulated dose, ECG showed no further changes. Thirty-seven (24.5%) cases had various types of abnormal ECG, manifested as arrhythmia in 11, non-specific ST-T changes in 12 and low voltage in 14. Of these 37 patients, fatal congestive heart failure developed in 4 cases. To reduce ADM cardiotoxicity, its indication should be strictly adhered to; ADM may be divided to two fractions on Day 1 and 2, for those patients receiving simultaneous CTX or who had had mediastinal irradiation, ADM accumulated dose should be limited to 400 mg/m2; ADM should never be given to patients with lowered QRS voltage greater than or equal to 30% of the normal value or with obvious ST-T changes; the accumulated doses should range from 450 to 550 mg/m2, simultaneous anti-histamines, anti-adrenaline, coenzyme Q10 and vitamin E are indicated.