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儿童癌症幸存者蒽环类药物心脏毒性的当前观点

Current Views on Anthracycline Cardiotoxicity in Childhood Cancer Survivors.

作者信息

Sadurska Elżbieta

机构信息

Department of Pediatric Cardiology, Medical University of Lublin, Chodźki 2, 20-093, Lublin, Poland,

出版信息

Pediatr Cardiol. 2015 Aug;36(6):1112-9. doi: 10.1007/s00246-015-1176-7. Epub 2015 May 5.

Abstract

Owing to their high efficacy, anthracycline antibiotics are included in numerous chemotherapeutic regimens used-often in combination with radiation therapy and/or surgery-in treatment of solid tumours and blood malignancies, both in children and adults. However, the efficacy of modern cancer treatments, owing to which the population of cancer survivors has been on the rise in recent years, may be limited by the risk of serious complications involving multiple organs and systems, including the cardiovascular system. Being an important side effect of anthracyclines, cardiotoxicity may limit the efficacy of cancer therapies in the acute phase (i.e. during the treatment) and induce the long-term sequelae, observed years after treatment completion in childhood cancer survivors. It is very important to understand the cardiotoxicity-associated mechanisms and to determine its risk factors in order to develop and/or improve the effective countermeasures. Based on published data, the paper provides an outline of current views on anthracycline cardiotoxicity and discusses such aspects as molecular mechanisms of cardiotoxicity and its clinical manifestations as well as the new preventive strategies and diagnostic techniques used for the assessment of cardiovascular abnormalities. The widespread awareness of cancer treatment-related cardiotoxicity among the healthcare professionals may significantly improve the quality of life of the childhood cancer survivors.

摘要

由于其高效性,蒽环类抗生素被纳入众多化疗方案中,常用于治疗儿童和成人的实体瘤及血液系统恶性肿瘤,常与放射治疗和/或手术联合使用。然而,近年来癌症幸存者人数不断增加的现代癌症治疗方法的疗效,可能会受到包括心血管系统在内的多个器官和系统严重并发症风险的限制。作为蒽环类药物的重要副作用,心脏毒性可能会在急性期(即治疗期间)限制癌症治疗的疗效,并引发长期后遗症,这些后遗症在儿童癌症幸存者完成治疗数年后才会出现。了解与心脏毒性相关的机制并确定其危险因素,对于开发和/或改进有效的应对措施非常重要。基于已发表的数据,本文概述了目前对蒽环类药物心脏毒性的看法,并讨论了心脏毒性的分子机制及其临床表现等方面,以及用于评估心血管异常的新预防策略和诊断技术。医疗保健专业人员对癌症治疗相关心脏毒性的广泛认识,可能会显著提高儿童癌症幸存者的生活质量。

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