2018 Volume 55 Issue 3 Pages 309-314
A 3-year-old female with nephroblastoma received doxorubicin (DOX)-containing adjuvant chemotherapy in combination with 10.5 Gy of whole abdominal irradiation. Twenty-five weeks after the start of treatment (cumulative dose of DOX: 116 mg/m2), she was tachypneic with low oxygen saturation. Chest X-ray demonstrated bilateral pulmonary congestion and pleural effusion, and marked cardiac dilation. Echocardiography demonstrated a decrease in the left ventricular ejection fraction (36%). Under diagnosis of acute cardiac failure, fluid restriction as well as intravenous treatment with dobutamine, olprinone, human atrial natriuretic peptide, and furosemide relieved symptoms of heart failure. Nine months after chemotherapy, she was alive without any disease and her cardiac function was improved by treatment with oral enalapril, carvedilol, and furosemide. Patients with nephroblastoma may potentially develop severe cardiotoxicity despite a lower cumulative dose of DOX, since they often have other risk factors for cardiotoxicity, such as younger age at diagnosis and irradiation around the heart.
