Treatment-related cardiotoxicity in survivors of childhood cancer

Key Points Advances in treatment have increased the number of childhood cancer survivors with late-occurring, treatment-related cardiovascular complications Treatment-induced cardiovascular events associated with chemotherapy and radiotherapy include cardiomyopathy, conduction defects, myocardial infarction, hypertension, stroke, pulmonary oedema, dyspnoea, and exercise intolerance The likelihood that subclinical damage will progress to clinically important events emphasizes the importance of reducing or eliminating this early damage Protective strategies that have been partially tested include administering cardioprotective agents, using less-toxic anthracycline derivatives and correcting therapy-related endocrinopathies that affect cardiovascular disease development Traditional cardiovascular risk factors, in addition to factors directly related to cancer treatments, can further increase the risk of cardiovascular complications in survivors Cancer treatment protocols should be refined to minimize cardiovascular and other adverse effects while maintaining acceptable cancer treatment response rates