Cardiovascular Disease in Adult Survivors of Childhood Cancer

被引:88
作者
Lipshultz, Steven E. [1 ,2 ]
Franco, Vivian I. [1 ]
Miller, Tracie L. [3 ]
Colan, Steven D. [4 ,5 ]
Sallan, Stephen E. [5 ,6 ,7 ]
机构
[1] Wayne State Univ, Sch Med, Dept Pediat, Detroit, MI 48201 USA
[2] Childrens Hosp Michigan, Detroit, MI 48201 USA
[3] Univ Miami, Miller Sch Med, Dept Pediat, Miami, FL 33101 USA
[4] Boston Childrens Hosp, Dept Cardiol, Boston, MA 02115 USA
[5] Harvard Univ, Sch Med, Dept Pediat, Boston, MA 02115 USA
[6] Dana Farber Canc Inst, Div Pediat Oncol, Boston, MA 02115 USA
[7] Boston Childrens Hosp, Boston, MA 02115 USA
来源
ANNUAL REVIEW OF MEDICINE, VOL 66 | 2015年 / 66卷
关键词
etiology; screening; prevention; treatment; ACUTE LYMPHOBLASTIC-LEUKEMIA; ANTHRACYCLINE-INDUCED CARDIOTOXICITY; LONG-TERM SURVIVORS; DEXRAZOXANE-ASSOCIATED RISK; DOXORUBICIN-TREATED SURVIVORS; PEDIATRIC HODGKINS-DISEASE; CONGESTIVE-HEART-FAILURE; CHRONIC MYELOID-LEUKEMIA; REFRACTORY SOLID TUMORS; PHASE-I TRIAL;
D O I
10.1146/annurev-med-070213-054849
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Treatment advances have increased survival in children with cancer, but subclinical, progressive, irreversible, and sometimes fatal treatment-related cardiovascular effects may appear years later. Cardio-oncologists have identified promising preventive and treatment strategies. Dexrazoxane provides long-term cardioprotection from doxorubicin-associated cardiotoxicity without compromising the efficacy of anticancer treatment. Continuous infusion of doxorubicin is as effective as bolus administration in leukemia treatment, but no evidence has indicated that it provides long-term cardioprotection; continuous infusions should be eliminated from pediatric cancer treatment. Angiotensin-converting enzyme inhibitors can delay the progression of subclinical and clinical cardiotoxicity. All survivors, regardless of whether they were treated with anthracyclines or radiation, should be monitored for systemic inflammation and the risk of premature cardiovascular disease. Echocardiographic screening must be supplemented with screening for biomarkers of cardiotoxicity and perhaps by identification of genetic susceptibilities to cardiovascular diseases; optimal strategies need to be identified. The health burden related to cancer treatment will increase as this population expands and ages.
引用
收藏
页码:161 / 176
页数:16
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