Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx NY, USA.
Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo NY, USA.
Expert Rev Cardiovasc Ther. 2021 Nov;19(11):957-974. doi: 10.1080/14779072.2021.2013811. Epub 2021 Dec 27.
Over the past five decades, the diagnosis and management of children with various malignancies have improved tremendously. As a result, an increasing number of children are long-term cancer survivors. With improved survival, however, has come an increased risk of treatment-related cardiovascular complications that can appear decades later.
This review discusses the pathophysiology, epidemiology and effects of treatment-related cardiovascular complications from anthracyclines and radiotherapy in pediatric lymphoma survivors. There is a paucity of evidence-based recommendations for screening for and treatment of cancer therapy-induced cardiovascular complications. We discuss current preventive measures and strategies for their treatment.
Significant cardiac adverse effects occur due to radiation and chemotherapy received by patients treated for lymphoma. Higher lifetime cumulative doses, female sex, longer follow-up, younger age, and preexisting cardiovascular disease are associated with a higher incidence of cardiotoxicity. With deeper understanding of the mechanisms of these adverse cardiac effects and identification of driver mutations causing these effects, personalized cancer therapy to limit cardiotoxic effects while ensuring an adequate anti-neoplastic effect would be ideal. In the meantime, expanding the use of cardioprotective agents with the best evidence such as dexrazoxane should be encouraged and further studied.
在过去的五十年中，儿童各种恶性肿瘤的诊断和治疗有了极大的改善。因此，越来越多的儿童成为长期癌症幸存者。然而，随着生存率的提高，治疗相关的心血管并发症的风险也增加了，这些并发症可能在几十年后才会出现。
本篇综述讨论了儿科淋巴瘤幸存者中蒽环类药物和放疗治疗相关心血管并发症的病理生理学、流行病学和影响。目前，对于筛查和治疗癌症治疗引起的心血管并发症，缺乏基于证据的推荐。我们讨论了目前的预防措施和治疗策略。
由于接受淋巴瘤治疗的患者接受了放疗和化疗，因此会出现严重的心脏不良影响。更高的终生累积剂量、女性、更长的随访时间、更年轻的年龄和预先存在的心血管疾病与更高的心脏毒性发生率相关。随着对这些不良心脏影响机制的深入了解，以及确定导致这些影响的驱动突变，理想情况下可以采用个性化的癌症治疗，在确保足够的抗肿瘤效果的同时限制心脏毒性作用。同时，应鼓励并进一步研究使用具有最佳证据的心脏保护剂，如右雷佐生。
