Cardiovascular diseases in survivors of childhood cancer

Abstract

Over the past few decades, the diagnosis and management of children with various malignancies have improved tremendously. As a result, there are an increasing number of children who are long-term cancer survivors. With improved survival, however, has come an increased risk of treatment-related cardiovascular complications that can appear decades after treatment. These problems are serious enough that all caregivers of childhood cancer survivors, including oncologists, cardiologists, and other health care personnel, must pay close attention to the short- and long-term effects of chemotherapy and radiotherapy on these children. This review discusses the effects of treatment-related cardiovascular complications from anthracyclines and radiotherapy and the methods for preventing, screening, and treating these complications.

Keywords: Cardio-oncology; Cardiotoxicity; Chemotherapy; Radiotherapy; Survivorship.

Figure 1.

Stages in the development of pediatric ventricular dysfunction. {Permission from Nature Publishing Group, Lipshultz SE, et al. Nat Rev Clin Oncol. 2013;10:697–710.}

Figure 2.. Model-based estimated probability of having A) an increased cardiac troponin T (cTnT) concentration or B) an elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration in patients treated with doxorubicin, with or without dexrazoxane.

The doxorubicin-dexrazoxane group is indicated by the blue line, the doxorubicin group by the gold line. Vertical bars show 95% confidence intervals. Increased cTnT is defined as a value greater than 0.01 ng/mL. *P vs. dexrazoxane group ≤0.05; †P vs. dexrazoxane group ≤0.001. An overall test for dexrazoxane effect during treatment was significant (P<0.001). Increased NT-proBNP is defined as a value of 150 pg/mL or greater for children less than1 year old and 100 pg/mL or greater for children aged at least 1 year. *P vs. dexrazoxane group ≤0.05; †P vs. dexrazoxane group ≤0.001. An overall test for dexrazoxane effect during treatment was significant (P<0.001) and after treatment was not significant (P=0.24). (Permission from American Society of Clinical Oncology c Lipshultz SE, et al. Lipshultz SE, Miller TL, Scully RE, et al. Changes in cardiac biomarkers during doxorubicin treatment of pediatric patients with high-risk acute lymphoblastic leukemia: associations with long-term echocardiographic outcomes. J Clin Oncol. 2012 Apr 1;30(10):1042–9. [133])