To the editor: Severe cardiomyopathy with irreversible congestive heart failure from adriamycin is very rare if the dose is limited to below 500 to 550 mg/m2 body surface area (1, 2). We have seen two patients who developed severe cardiac failure after receiving less than 500 mg/m2 body surface area of adriamycin in conjunction with therapeutic radiation to the thoracic spine and lungs. This seems to be a variable in the development of adriamycin cardiotoxicity. An 11-year-old girl with Ewing's sarcoma of the right ilium metastatic to the skull and thoracic spine has been treated since 1972 with