Treatment-related cardiotoxicity in survivors of childhood cancer

Steven E Lipshultz, Thomas R. Cochran, Vivian I. Franco, Tracie L Miller

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

Treatment advances and higher participation rates in clinical trials have rapidly increased the number of survivors of childhood cancer. However, chemotherapy and radiation treatments are cardiotoxic and can cause cardiomyopathy, conduction defects, myocardial infarction, hypertension, stroke, pulmonary oedema, dyspnoea and exercise intolerance later in life. These cardiotoxic effects are often progressive and irreversible, emphasizing a need for effective prevention and treatment to reduce or avoid cardiotoxicity. Medical interventions, such as angiotensin-converting enzyme inhibitors, β-blockers, and growth hormone therapy, might be used to treat cardiotoxicity in childhood cancer survivors. Preventative strategies should include the use of dexrazoxane, which provides cardioprotection without reducing the oncological efficacy of doxorubicin chemotherapy; less-toxic anthracycline derivatives and the use of antioxidant nutritional supplements might also be beneficial. Continuous-infusion doxorubicin provides no benefit over bolus infusion in children. Identifying patient-related (for example, obesity and hypertension) and drug-related (for example, cumulative dose) risk factors for cardiotoxicity could help tailor treatments to individual patients. However, all survivors of childhood cancer are at increased risk of cardiotoxicity, suggesting that survivor screening recommendations for assessment of global risk of premature cardiovascular disease should apply to all survivors. Optimal, evidence-based monitoring strategies and multiagent preventative treatments still need to be identified.

Original languageEnglish
Pages (from-to)697-710
Number of pages14
JournalNature Reviews Clinical Oncology
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2013

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Survivors
Neoplasms
Doxorubicin
Therapeutics
Dexrazoxane
Hypertension
Drug Therapy
Poisons
Anthracyclines
Pulmonary Edema
Cardiomyopathies
Angiotensin-Converting Enzyme Inhibitors
Dyspnea
Growth Hormone
Cardiotoxicity
Cardiovascular Diseases
Obesity
Antioxidants
Stroke
Myocardial Infarction

ASJC Scopus subject areas

  • Oncology

Cite this

Lipshultz, S. E., Cochran, T. R., Franco, V. I., & Miller, T. L. (2013). Treatment-related cardiotoxicity in survivors of childhood cancer. Nature Reviews Clinical Oncology, 10(12), 697-710. https://doi.org/10.1038/nrclinonc.2013.195

Treatment-related cardiotoxicity in survivors of childhood cancer. / Lipshultz, Steven E; Cochran, Thomas R.; Franco, Vivian I.; Miller, Tracie L.

In: Nature Reviews Clinical Oncology, Vol. 10, No. 12, 01.12.2013, p. 697-710.

Research output: Contribution to journalArticle

Lipshultz, SE, Cochran, TR, Franco, VI & Miller, TL 2013, 'Treatment-related cardiotoxicity in survivors of childhood cancer', Nature Reviews Clinical Oncology, vol. 10, no. 12, pp. 697-710. https://doi.org/10.1038/nrclinonc.2013.195
Lipshultz, Steven E ; Cochran, Thomas R. ; Franco, Vivian I. ; Miller, Tracie L. / Treatment-related cardiotoxicity in survivors of childhood cancer. In: Nature Reviews Clinical Oncology. 2013 ; Vol. 10, No. 12. pp. 697-710.
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