title: Anthracycline-related cardiotoxicity in childhood cancer survivors.
abstract: OBJECTIVE
  Anthracyclines have markedly improved the survival rates of children with cancer. However, anthracycline-related cardiotoxicity is also well recognized and can compromise the long-term outcome in some patients. The challenge remains of how to balance the chemotherapeutic effects of anthracycline treatment with its potentially serious cardiovascular complications. Here, we review the pathophysiology, risk factors, clinical manifestations, prevention, and treatment of anthracycline-related cardiotoxicity.
  
  
  RESULTS
  Some risk factors and biomarkers associated with an increased probability of anthracycline-related cardiotoxicity have been identified. Modifying the structural forms and dosages of anthracyclines and coadministering cardioprotective agents may prevent some of these cardiotoxic effects. Cardiovascular complications have also been treated with angiotensin-converting enzyme inhibitors, β-blockers, and growth hormone replacement therapy. Cardiac transplantation remains the treatment of last resort.
  
  
  CONCLUSIONS
  Despite major advances in cancer treatment, anthracycline-related cardiotoxicity remains a major cause of morbidity and mortality in survivors of childhood cancer. Promising areas of research include: use of biomarkers for early recognition of cardiac injury in children receiving chemotherapy, development and application of cardioprotective agents for prevention of cardiotoxicity, and advancements in therapies for cardiac dysfunction in children after anthracycline treatment.
authors.affiliation: aDepartment of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, Michigan bDepartment of Pediatrics, University of Miami Miller School of Medicine cHoltz Children's Hospital of the Jackson Health System, Miami, Florida, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lipshultz
authors.forename: Ruchika
authors.initials: R
authors.lastname: Karnik
authors.forename: Peter
authors.initials: P
authors.lastname: Sambatakos
authors.forename: Vivian I
authors.initials: VI
authors.lastname: Franco
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Ross
authors.forename: Tracie L
authors.initials: TL
authors.lastname: Miller
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D018943:Anthracyclines / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D018450:Disease Progression; D006333:Heart Failure / Q000139:chemically induced* / Q000517:prevention & control / Q000628:therapy; D016027:Heart Transplantation; D019382:Human Growth Hormone / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000517:prevention & control / Q000628:therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D018943:Anthracyclines; D000970:Antineoplastic Agents; D002316:Cardiotonic Agents; D019382:Human Growth Hormone