Department of Cardiology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
Circ Res. 2011 Mar 4;108(5):619-28. doi: 10.1161/CIRCRESAHA.110.224519.
Although important advances have been made in curing childhood cancer in the last several decades, long-term survivors face considerable morbidity and mortality because of late effects from their initial anticancer therapy. By 30 years after treatment, the cumulative mortality from treatment-related medical illness actually exceeds that of mortality from cancer recurrence. Cardiovascular disease, in particular, is a leading threat to the well-being of adult survivors of childhood cancers. Unfortunately, the mechanisms of these late cardiac effects are understudied and poorly understood. This article reviews cardiotoxicity associated with 2 major anticancer regimens used in treating childhood cancer patients: anthracycline treatment and radiation therapy. The known pathophysiology and clinical cardiac risk factors that further predispose these patients to late-onset cardiac events are discussed. Basic and translational research is urgently needed to clarify pathophysiologic mechanisms of late cardiac effects and to develop therapies to improve both long-term survival and quality of life of adults cured of pediatric cancers.
尽管在过去几十年中，治愈儿童癌症方面取得了重要进展，但由于初始抗癌治疗的晚期影响，长期幸存者仍面临相当大的发病率和死亡率。在治疗后 30 年，与治疗相关的医疗疾病导致的死亡率实际上超过了癌症复发导致的死亡率。心血管疾病尤其对儿童癌症成年幸存者的健康构成主要威胁。不幸的是，这些晚期心脏影响的机制尚未得到充分研究和理解。本文回顾了与治疗儿童癌症患者的两种主要抗癌方案相关的心脏毒性：蒽环类药物治疗和放射治疗。讨论了已知的病理生理学和临床心脏危险因素，这些危险因素进一步使这些患者易发生迟发性心脏事件。迫切需要基础和转化研究来阐明晚期心脏影响的病理生理机制，并开发改善儿科癌症治愈成人的长期生存和生活质量的治疗方法。
