Pediatric cardio-oncology – review of current state
DOI:
https://doi.org/10.13112/pc.1092Keywords:
ANTHRACYCLINES; CARDIOTOXICITY; PEDIATRICS; CARDIOLOGY-ONCOLOGY; RISK ASSESSMENT; ECHOCARDIOGRAPHYAbstract
Improved diagnostics and treatment methods have resulted in significant improvements in the survival of children with malignant diseases, and the proportion of adults who were oncological patients in childhood is increasing. At the same time, improved survival is accompanied by an increased rate of associated long-term therapy complications. These conditions include secondary tumors, endocrine disorders, cardiopulmonary dysfunction, renal dysfunction, and neurosensory damage. Heart complications are a leading cause of death for childhood cancer survivors, second only to cancer relapse.
Various chemotherapeutic agents are associated with various cardiovascular complications. A strong dose-dependent association is known between anthracycline chemotherapy and the risk of heart failure, and the risk is higher with additional exposure to chest radiation. The spectrum of cardiovascular toxicity associated with oncological treatment includes: asymptomatic and symptomatic cardiac dysfunction (heart failure), myocarditis, asymptomatic and symptomatic vascular toxicity, arterial hypertension, and cardiac arrhythmias. In the pediatric population, there is a lack of guidelines aimed at prevention and treatment modalities, which results in substantial practice variability.
For imaging surveillance, echocardiography remains the mainstay because of its safety profile and widespread availability. Subclinical cardiotoxicity may be detected using laboratory biomarkers such as cardiac troponin and brain natriuretic peptide.
The rapidly growing field of pediatric cardio-oncology should shift to a more proactive approach. Collaboration between pediatric cardiologists, oncologists, and other specialists is crucial for better understanding, treatment, and, if possible, prevention of cardiac diseases in pediatric oncology patients.
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