2012, Number 4
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ABSTRACTThe aim of chemotherapy is the destruction of tumor cells, is classified as adjuvant, neoadjuvant or induction, concomitant with radiation therapy, palliative monotherapy, chemotherapy, combined and sequential. The main drugs: alkylating agents, platinum agents, antimetabolites, topoisomerase inhibitors, microtubule inhibitors, and miscellaneous. Secondary effects on the heart are cardiomyopathies chemotherapy induce, acute cardiotoxicity, and chronic cardiotoxicity. Late cardiotoxicity. Cardiac arrhythmias, ischemic heart disease and second neoplasic, particularly hematologic (leukemia, lymphomas) and solid tumors that evolve with increased morbility and mortality. Case report: Female of 36 years old. Right breast Cancer in 2005 received neoadjuvant chemotherapy of 4 cycles and other 4 adjuvant cycles. Radical Mastectomy and Axillary Radical Dissection, Radiotherapy, complete breast cycle. Subsequently, hormone therapy until October 2009. In December 2009 tumor exeresis in feb.2010 left buttock, with reports of malignancy. Removal of buttock was on August 2010, with a diagnosis of pleomorphic rhabdomyosarcoma, with treatment adjuvant radiotherapy (51.5 Gy) and adjuvant chemotherapy with cisplatin and doxorubicin, 3 cycles. In March, 2011 goes to the fourth cycle, dyspnoea 4 days of evolution of small efforts, and paroxysmal nocturnal chest pain, oppressive, 6 hours, after walking home and a productive cough. E.F: ta 60/30, fc 130 L x min, did not tolerate lying, pale, diaphoretic, thready pulse, yugular plethora, fc 150 x min gallop. Electrocardiogram: qs in v1, embryonic r in v2- v3. ECOTT: FEVI 28%, generalized hypokinesia LV septal wall thinning. Was diagnosed heart insufficiency (according to Framingham criteria) and septal infarct. This is due to the increased survival of cancer and side effects of treatment, which should apply in these patients Routine ECG, ECOTT and so we can start early management and prevent or postpone these late stages.
Citron ML, Berry DA, Cirrincione C, et al. Randomized trial of dose-dense vs. Conventionally scheduled and sequential vs. concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol 2003;21(8):1431-1439.