Cardiovascular disease in survivors of childhood cancer : Current Opinion in Pediatrics

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CARDIOVASCULAR MEDICINE: Edited by Daniel Bernstein

Cardiovascular disease in survivors of childhood cancer

Bansal, Nehaa; Amdani, Shahnawaz M.b; Hutchins, Kelley K.c; Lipshultz, Steven E.a,d,e

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Current Opinion in Pediatrics 30(5):p 628-638, October 2018. | DOI: 10.1097/MOP.0000000000000675


Purpose of review 

We review the cardiotoxic chemotherapeutic agents, the clinical and subclinical presentations and progression of their cardiotoxicity, and the management of the subsequent cardiovascular disease in survivors of childhood cancer. We discuss various preventive measures, especially the cardioprotectant, dexrazoxane, whose use with anthracycline chemotherapy, including doxorubicin, is based on strong evidence. Most treatment recommendations for this unique population are based on expert opinion, not on empirical evidence.

Recent findings 

As patients with childhood cancers live longer, morbidity from the cardiac side effects of chemotherapy is increasing. Treatment-related cardiac damage is irreversible and often progressive. It is imperative that such damage be prevented with strategies such as limiting the cumulative anthracycline dose, the use of anthracycline structural analogues and the use of cardioprotective agents.


A deeper understanding of the mechanisms of their cardiotoxicity reveals that there is no ‘safe’ dose of anthracyclines. However, certain risk factors, such as higher lifetime anthracycline cumulative doses, higher anthracycline dose rates, female sex, longer follow-up, younger age at anthracycline treatment and cardiac irradiation, are associated with more severe cardiotoxicity. We advocate the use of dexrazoxane to limit the cardiotoxic effects of anthracycline chemotherapy.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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