18+ years remission/post chemo risk

[LukeL]

6/88 dx with rhabdomyosarcoma complete removal with no microscopic remains/clean margins. Placed on adriamycin, vincristine, and cytoxan. On adriamycin for only 1-2 months rest of drugs on for 16 months.

Was wondering what kind of cardiac risk I would have from adriamycin, and what kind of cardiac damage it can cause. Also what the risk is of male infertility, considering the chemo and that the tumor was in my groin and encroaching on left testicle which was removed as a precautionary measure.

[Fernando Roque, MD]

Hi.  Adriamycin can damage heart muscles and cause the heart to fail to pump properly. Your risk of developing heart failure as a result of adriamycin depends on the cumulative dose you received.  Cardiac toxicity is usually avoided when the cumulative dose of adriamycin does not exceed 450 milligrams per meter squared (Note: chemotherapy doses are usually computed based on the body surface area - mg/m2. This comes out to a total cumulative dose of between 650 to 900 mg).  Since you have only been on adriamycin for 1-2 months, I don't expect you to have exceeded this ceiling dose.

If you already have a heart condition (example: ischemic heart disease) prior to the treatment, you may be at an increased risk of cardiac toxicity even if the dose you received did not exceed the ceiling dose.  Patients who are given this drug are usually subjected to periodic echocardiograms to check for any deterioration while under treatment.  If you're worried about the status of your heart, you can request an echocardiogram to be repeated.

As for infertility, all three drugs (adriamycin, vincristine and cytoxan) have the potential for causing permanent infertility.  A combination of adriamycin and cytoxan, for example, can cause infertility in 13 - 60% of patients, depending on the age when chemotherapy was given (13-30% in those who had chemotherapy at less than 40 years old, and 57-60% for those at least 40 years old).  If you're concerned about infertility, you can have your semen analyzed in a lab.

[LukeL]

Thank You for your prompt reply. I have tried to look this stuff up on the internet and it is far to technical for me to grasp. I was 3 when I was dx and had repeat echos until 10 years of age with clear results, and recently had an echo for an unrealted problem and showed only mild LVH.

[Fernando Roque, MD]

Hi. Mild LVH (left ventricular hypertrophy) means a slight thickening of the heart muscles in one of the chambers of the heart (the left ventricle). This isn't something to worry about. The effect of adriamycin would be the exact opposite - thinning of heart muscles.