Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Fla., USA.
Acta Haematol. 2014;132(3-4):391-9. doi: 10.1159/000360238. Epub 2014 Sep 10.
Children diagnosed with cancer are now living longer as a result of advances in treatment. However, some commonly used anticancer drugs, although effective in curing cancer, can also cause adverse late effects. The cardiotoxic effects of anthracycline chemotherapy, such as doxorubicin, and radiation can cause persistent and progressive cardiovascular damage, emphasizing a need for effective prevention and treatment to reduce or avoid cardiotoxicity. Examples of risk factors for cardiotoxicity in children include higher anthracycline cumulative dose, higher dose of radiation, younger age at diagnosis, female sex, trisomy 21 and black race. However, not all who are exposed to toxic treatments experience cardiotoxicity, suggesting the possibility of a genetic predisposition. Cardioprotective strategies under investigation include the use of dexrazoxane, which provides short- and long-term cardioprotection in children treated with doxorubicin without interfering with oncological efficacy, the use of less toxic anthracycline derivatives and nutritional supplements. Evidence-based monitoring and screening are needed to identify early signs of cardiotoxicity that have been validated as surrogates of subsequent clinically significant cardiovascular disease before the occurrence of cardiac damage, in patients who may be at higher risk.
由于治疗的进步，现在被诊断患有癌症的儿童的寿命更长了。然而，一些常用的抗癌药物虽然在治疗癌症方面有效，但也会引起不良的晚期效应。蒽环类化疗药物（如多柔比星）和放疗的心脏毒性作用会导致持续和进行性的心血管损伤，这强调了需要有效的预防和治疗措施来减少或避免心脏毒性。儿童心脏毒性的危险因素包括蒽环类药物累积剂量较高、辐射剂量较高、诊断时年龄较小、女性、21 三体和黑种人。然而，并非所有接触有毒治疗的人都经历心脏毒性，这表明存在遗传易感性的可能性。正在研究的心脏保护策略包括使用右雷佐生，它在不影响肿瘤疗效的情况下为接受多柔比星治疗的儿童提供短期和长期的心脏保护作用，使用毒性较小的蒽环类衍生物和营养补充剂。需要进行基于证据的监测和筛查，以识别心脏毒性的早期迹象，这些迹象已经被验证为发生心脏损伤之前随后发生的临床显著心血管疾病的替代指标，对于那些可能处于更高风险的患者来说。
