Abstract
Çocukluk
çağı kanserlerinde sağ-kalım sonrası kardiyovasküler hastalık riski kontrol
gruplarına göre 8-10 kat daha fazla bulunmuştur. Bu konuda yapılan çalışmalar
kardiyovasküler hastalıklardan ölüm riskinin tedavi tamamlandıktan 5-10 yıl
sonra belirgin arttığını, tanı üzerinden 30 yıldan uzun süre geçen hastalarda
kardiyak toksisiteye bağlı hastalıkların en önemli mortalite nedeni olduğunu
göstermiştir. Bu nedenle tedavi sırasında ve sonrasında hastaların düzenli
takibi gerekmektedir. Örneğin, antrasiklin tedavisi verilen ve tedavi üzerinden
10 yıldan uzun süre geçen hastaların yaklaşık yarısında, hiçbir semptom
bulunmasa bile subklinik kardiyak hastalık bulunmaktadır. Sağ-kalım sonrası tüm
hastalar dikkate alındığında bu rakam %25’in üzerindedir. Bu sonuçlar subklinik
bulguların yıllar içerisinde kötüleşeceğini göstermektedir. Çocuklarda
kemoterapiye bağlı toksisiteyi ve uzun dönemde toksisitenin nasıl
sonuçlanacağını tahmin etmek her zaman mümkün değildir. Direkt miyokard hasarı
yanında miyokardiyal fonksiyon kaybı yada vasküler hemodinaminin bozulması gibi
kemoterapiye bağlı değişiklikler kardiyovasküler sistemi etkileyebilir. Kardiyovasküler
sistem ayrıca radyasyon hasarına da açıktır. Temel mekanizma interstisyel
fibrozis gelişmesidir. Tedavisi devam eden hastalarda kardiyovasküler sistem
ile ilgili bazal değerlerin elde edilmesi ve erken bulguların saptanabilmesi
amacıyla düzenli aralarla tanısal değerlendirme yapılmalıdır. Tedavisi
tamamlanan hastalarda ise genel kabul görmüş yaklaşım asemptomatik hastalarda bu
değerlendirmenin 5 yılda bir yapılması, semptomatik hastalarda ise semptomlar
başladığında yapılarak bulgulara göre sıklığının belirlenmesi gerektiği
şeklindedir. Ayrıca en düşük etkili dozun belirlenmesi, alternatif doz ve
uygulama metodlarının geliştirilmesi, protokollere kardiyak koruyucu ajanların
eklenmesi, radyoterapi kullanımı ve dozunun azaltılması ile kardiyak
toksisiteye bağlı hastalık insidansının azaltılması üzerine yeni tedavi
protokolleri geliştirilmelidir. Sağ-kalım sonrası obezitenin önlenmesi,
metabolik sendrom ve hipertansiyon ile mücadele, hiperlipideminin önlenmesi,
erken ateroskleroz gelişiminin takibi, aritmi açısından dikkatli olunması,
sigara, alkol kullanımı ve madde alışkanlığı ile mücadele de önemlidir.
Keywords
References
- 1. Cardinale D, Sandri MT, Colombo A, et al. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation 2004; 109: 2749-2754.
- 2. Lipshultz SE, Rifai N, Dalton VM, et al. The effect of dexrazoxane on myocardial injury in doxorubicin-treated children with acute lymphoblastic leukemia. N Engl J Med 2004; 351: 145-153.
- 3. Nakamae H, Tsumura K, Terada Y, et al. Notable effects of angiotensin II receptor blocker, valsartan on acute cardiotoxic changes after standart chemotherapy with cyclophospahamide, doxorubicin, vincristine and prednisolone. Cancer 2005; 104: 2492-2498.
- 4. Kalay N, Basar E, Ozdogru I, et al. Protective effects of carvedilol against anthracycline-induced cardiomyopathy. J Am Coll Cardiol 2006; 48: 2258-2262.
- 5. Cardinale D, Colombo A, Sandri MT, et al. Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition. Circulation 2006; 114: 2474-2481.
- 6. Cadeddu C, Piras A, Mantovani G, et al. Protective effects of the angiotensin II receptor blocker telmisartan on epirubicin-induced inflammation, oxidative stres and early ventricular impairement. Am Heart J 2010; 160: 487 (e1-7).
- 7. Yeh ET, Bickford CL. Cardiovascular complications of cancer thrapy: Incidence, pathogenesis, diagnosis and management. J Am Coll Cardiol 2009; 53: 2231-2247.
- 8. Altena R, Perik PJ, van Veldhuisen DJ, et al. Cardiovascular toxicity caused by cancer treatment: Strategies for early detection. Lancet Oncol 2009; 10: 391-399.
- 9. Lipshultz SE, Scully RE, Lipsitz SR, et al. Assessment of dexrazoxane as a cardioprotectant in doxorubicin-treated children with high-risk acute lymphoblastic leukemia: Long-term follow-up of a prospective, randomised, multicentretrial. Lancet Oncol 2010; 11: 950-961.
- 10. Georgakopoulos P, Roussou P, Matsakas E, et al. Cardioprotective effect of metoprolol and enalapril in doxorubicin-treated lymphoma patients: A prospective, parallel group, randomized, controlled study with 36-month follow-up. Am J Hematol 2010; 85: 894-896.
- 11. Tacyildiz N, Ozyoruk D, Ozelci Kavas G, et al. Selenium in the prevention of anthracycline-induced cardiac toxicity in children with cancer. J Oncol 2012; DOI: 10.1155/2012/651630.
- 12. Lipshultz SE, Adams MJ, Colan SD, et al. Long-term cardiovascular toxicity in children, adolescents and young adults who receive cancer therapy: Pathophysiology, course, monitoring, management, prevention and research directions. A scientific statement from the American Heart Association. Circulation 2013; 128: 1927-1995.
- 13. Berardi R, Caramanti M, Savini A, et al. State of the art for cardiotoxicity due to chemotherapy and to targeted therapies: A literature review. Crit Rev Oncol Hematol 2013; 88: 75-86.
- 14. Kaya MG, Ozkan M, Gunebakmaz O, et al. Protective effects of nebivolol against anthracycline-induced cardiomyopathy: A randomized control study. Int J Cardiol 2013; 167: 2306-2310.
- 15. Truong J, Yan AT, Cramarossa G, et al. Chemotherapy-induced cardiotoxicity: Detection, prevention and management. Can J Cardiol 2014; 30: 869-878.
- 16. Bhakta N, Liu Q, Yeo F, et al. Cumulative burden of cardiovascular morbidity among pediatric, adolescent and young adult Hodgkin Lymphoma survivors: An analysis from the St. Jude Lifetime Cohort Study. Lancet Oncol 2016; 17: 1325-1334.
Abstract
References
- 1. Cardinale D, Sandri MT, Colombo A, et al. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation 2004; 109: 2749-2754.
- 2. Lipshultz SE, Rifai N, Dalton VM, et al. The effect of dexrazoxane on myocardial injury in doxorubicin-treated children with acute lymphoblastic leukemia. N Engl J Med 2004; 351: 145-153.
- 3. Nakamae H, Tsumura K, Terada Y, et al. Notable effects of angiotensin II receptor blocker, valsartan on acute cardiotoxic changes after standart chemotherapy with cyclophospahamide, doxorubicin, vincristine and prednisolone. Cancer 2005; 104: 2492-2498.
- 4. Kalay N, Basar E, Ozdogru I, et al. Protective effects of carvedilol against anthracycline-induced cardiomyopathy. J Am Coll Cardiol 2006; 48: 2258-2262.
- 5. Cardinale D, Colombo A, Sandri MT, et al. Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition. Circulation 2006; 114: 2474-2481.
- 6. Cadeddu C, Piras A, Mantovani G, et al. Protective effects of the angiotensin II receptor blocker telmisartan on epirubicin-induced inflammation, oxidative stres and early ventricular impairement. Am Heart J 2010; 160: 487 (e1-7).
- 7. Yeh ET, Bickford CL. Cardiovascular complications of cancer thrapy: Incidence, pathogenesis, diagnosis and management. J Am Coll Cardiol 2009; 53: 2231-2247.
- 8. Altena R, Perik PJ, van Veldhuisen DJ, et al. Cardiovascular toxicity caused by cancer treatment: Strategies for early detection. Lancet Oncol 2009; 10: 391-399.
- 9. Lipshultz SE, Scully RE, Lipsitz SR, et al. Assessment of dexrazoxane as a cardioprotectant in doxorubicin-treated children with high-risk acute lymphoblastic leukemia: Long-term follow-up of a prospective, randomised, multicentretrial. Lancet Oncol 2010; 11: 950-961.
- 10. Georgakopoulos P, Roussou P, Matsakas E, et al. Cardioprotective effect of metoprolol and enalapril in doxorubicin-treated lymphoma patients: A prospective, parallel group, randomized, controlled study with 36-month follow-up. Am J Hematol 2010; 85: 894-896.
- 11. Tacyildiz N, Ozyoruk D, Ozelci Kavas G, et al. Selenium in the prevention of anthracycline-induced cardiac toxicity in children with cancer. J Oncol 2012; DOI: 10.1155/2012/651630.
- 12. Lipshultz SE, Adams MJ, Colan SD, et al. Long-term cardiovascular toxicity in children, adolescents and young adults who receive cancer therapy: Pathophysiology, course, monitoring, management, prevention and research directions. A scientific statement from the American Heart Association. Circulation 2013; 128: 1927-1995.
- 13. Berardi R, Caramanti M, Savini A, et al. State of the art for cardiotoxicity due to chemotherapy and to targeted therapies: A literature review. Crit Rev Oncol Hematol 2013; 88: 75-86.
- 14. Kaya MG, Ozkan M, Gunebakmaz O, et al. Protective effects of nebivolol against anthracycline-induced cardiomyopathy: A randomized control study. Int J Cardiol 2013; 167: 2306-2310.
- 15. Truong J, Yan AT, Cramarossa G, et al. Chemotherapy-induced cardiotoxicity: Detection, prevention and management. Can J Cardiol 2014; 30: 869-878.
- 16. Bhakta N, Liu Q, Yeo F, et al. Cumulative burden of cardiovascular morbidity among pediatric, adolescent and young adult Hodgkin Lymphoma survivors: An analysis from the St. Jude Lifetime Cohort Study. Lancet Oncol 2016; 17: 1325-1334.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | REVIEW |
| Authors | |
| Publication Date | September 23, 2019 |
| Submission Date | May 6, 2019 |
| Published in Issue | Year 2019 Volume: 13 Issue: 5 |
The publication language of Turkish Journal of Pediatric Disease is English.
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