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Cardiotoxicity in Children

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Manual of Cardio-oncology

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Abstract

During the last decades, advances in cancer treatment strategies led to a substantial improvement in the 5-year survival rate of children (age 0–14) with cancer, moving from less than 60 % in the 1970s to more than 80 % in 2010. It is estimated that about 75–80 % of children with cancer diagnosed in these days will be still alive after 10 years from diagnosis. However, about 40–75 % of them will experience at least one chronic treatment-related condition by the first 30 years after diagnosis.

Nearly 60 % of all childhood cancer survivors (CCS) carry a history of prior anthracyclines and/or chest radiation exposure. CCS treated with anthracyclines and cardiac radiation are at risk for late-onset cardiovascular toxicity that represent the most serious and frequent long-term complications in CCS, after cancer recurrence and second malignancy.

Among cardiovascular complications, cardiomyopathy and congestive heart failure (CHF) are the most common and life-limiting consequences. However, patients can also present myocardial ischemia, arrhythmias, hypertension, and thromboembolism. It must be noted that not all children and adolescents exposed to toxic treatments, even those who receive the same standardized chemotherapeutic regimens, experience cardiotoxicity; this suggests the possibility of a genetic predisposition.

Chemotherapy-induced cardiotoxicity remains an unresolved problem strongly impacting the quality of life and the overall survival of childhood cancer patients. Accurate lifestyle guidelines and cardiology-screening programs are mandatory in order to prevent and/or early identify signs and symptoms of cardiotoxicity. Early detection and treatment of subclinical cardiomyopathy might improve long-term outcome.

In the future, if genetic markers able to identify increased risk of cardiac complications after cancer treatment will be better identified, a risk-adapted approach basing the intensity of therapy on clinical, biological, and genetic factors might help to minimize the cardiotoxic effects of therapy without compromising its anticancer effect.

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Authors and Affiliations

  1. Cardiology Department, Istituto Giannina Gaslini, Genoa, Italy

    Francesca Cairello & Maria Derchi

  2. Epidemiology and Biostatistics Unit, Istituto Giannina Gaslini, Genoa, Italy

    Sara Pessano, Vera Morsellino & Riccardo Haupt

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  1. Francesca Cairello
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  2. Sara Pessano
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  3. Vera Morsellino
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  4. Riccardo Haupt
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  5. Maria Derchi
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Correspondence to Maria Derchi .

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Editors and Affiliations

  1. Cardiology Unit, IRCCS CRO-National Cancer Institute, Aviano (PN), Italy

    Chiara Lestuzzi

  2. Cardiology Unit, National Cancer Institute “Giovanni Paolo II”, Bari, Italy

    Stefano Oliva

  3. Medical Oncology Unit, Ospedale San Vincenzo, Taormina, Italy

    Francesco Ferraù

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Cairello, F., Pessano, S., Morsellino, V., Haupt, R., Derchi, M. (2017). Cardiotoxicity in Children. In: Lestuzzi, C., Oliva, S., Ferraù, F. (eds) Manual of Cardio-oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-40236-9_13

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  • DOI: https://doi.org/10.1007/978-3-319-40236-9_13

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