Cardio-Toxicity among Sarcoma Patients: A Cardio-Oncology Registry

Background: Chemotherapy induced cardio-toxicity has been recognized as a serious side effect since the first introduction to anthracycline (ANT). Cardio-toxicity among breast cancer patients is well studied but the impact on sarcoma patients is limited, even though they are exposed to higher ANT doses. The commonly used term for cardio-toxicity is cancer therapeutic related cardiac dysfunction (CTRCD), defined as a left ventricular ejection fraction (EF) reduction of >10%, to a value below 53%.

Objectives: To estimate the prevalence of CTRCD among sarcoma patients, to perform risk stratification for its development and evaluate whether CTRCD is associated with mortality.

Methods: Data were collected as part of the International Cardio-Oncology Registry (ICOR), enrolling all patients who were evaluated in the cardio-oncology clinic at our institution. All sarcoma patients were enrolled and divided into two groups - CTRCD group vs. "EF preserved" group.

Results: Among 43 consecutive patients, 6 (14%) developed CTRCD. Elevated left ventricular end systolic diameter (p=0.007), high levels of Red Blood Cell Distribution Width (p=0.044) and platelets (p=0.023) and a trend of lower Global Longitudinal Strain (p=0.092) were observed among the CTRCD group. During follow-up, 2 (33%) patients died in the CTRCD group vs 3 (8.1%) patients in the "EF preserved" group. In a multivariate analysis, adjusted to age and EF, CTRCD remained a significant predictor for mortality (p=0.039).

Conclusions: CTRCD is an important concern among sarcoma patients, regardless of baseline risk factors, and is associated with mortality. Echocardiography and blood parameters may provide an early diagnosis of cardio-toxicity.