Late cardiotoxicity after anthracycline therapy for childhood cancer is frequent, mostly subclinical, often progressive, potentially severe and sometimes fatal. The present article reviews all available studies of cardiac function more than 1 year after cessation of anthracycline therapy for childhood cancer. Late clinical cardiotoxicity occurs in 5-10% of long term survivors 5-10 years after therapy. Late clinical cardiotoxicity is often life threatening if not treated by cardiac transplantation. Clinical cardiotoxicity during or shortly after anthracycline therapy seems to be the most important risk factor for late clinical cardiotoxicity. In spite of many large studies on the subject, considerable controversy exists on the frequency, severity and risk factors of late subclinical cardiotoxicity following anthracycline therapy for childhood cancer. Some studies have found subclinical cardiac abnormalities in more than half of the participants 5-10 years after anthracycline therapy. Anthracycline cumulative dose and dose intensity are risk factors for late subclinical cardiotoxicity. Younger age at therapy, female sex and longer follow-up after therapy also seem to be associated with an increased risk. Risk factors for late subclinical cardiotoxicity may also increase the risk of late clinical cardiotoxicity, as subclinical cardiotoxicity may worsen over time and become clinical. During the first decade after anthracycline therapy for childhood cancer, cardiac toxicity only influences survival minimally. It is yet unknown whether late cardiotoxicity will significantly reduce the long-term survival or impair the quality of life of the survivors during the second and third decades following anthracycline therapy for childhood cancer.
- Delayed effects of therapy
- Left ventricular function
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine