Cardioprotection in Patients Undergoing Chemo- and/or Radiotherapy for Neoplastic Disease: A Pilot Study

Objectives: To assess the cardioprotective efficiency of an antioxidant regimen (vitamins E, C and N-acetylcysteine) in patients receiving high dose chemo- and/or radiotherapy for malignant disease. Methods: Prospective, placebo controlled, randomized and double blinded pilot study involving 13 patients receiving chemotherapy and 12 patients receiving radiotherapy. Results: In patients receiving antioxidants, left ventricular ejection fraction did not change (63±4% to 63±4%). In the placebo group, ejection fraction changed from 67±6% to 61±4% (p=0.03). No patient in the antioxidant group and 6/13 (46%) patients in the placebo group showed a fall of >10% in the left ventricular ejection fraction. In the chemotherapy group, the left ventricular ejection fraction changed from 62% (±2) to 63% (±2) in the patients treated with antioxidants (ns) and from 63% (±5) to 61% (±5) in patients treated with placebo (ns). No patient showed a significant fall in ejec-tion fraction in the antioxidant group, whereas 2/7 (29%) in the placebo group showed a reduction ≥10%. In the radiotherapy group, left ventricular ejection fraction did not change {64% (±6) to 64% (±5)} in patients treated with antioxidants (ns) and changed from 70% (±8) to 60% (±4) in patients treated with placebo (p=0.008). No patient in the antioxidant group, but 4/6 (66%) patients in the placebo group showed a fall of ≥10% in ejection fraction. Conclusion: The small number of patients in the study precludes a definitive statement. The preliminary results however suggest efficient cardioprotection by this nontoxic and inexpensive antioxidant combination, so larger studies are warranted for confirmation.