Risk Stratification for Cardiotoxicity in Childhood Cancer Survivors: State-of-the-Art Review and a Novel Two-Step...

Area of Science:

• Cardio-oncology
• Pediatric oncology
• Cardiovascular medicine

Background:

• Childhood cancer survivors (CCSs) are at elevated risk for late-onset cancer therapy-related cardiovascular toxicities (CTR-CVTs).
• Established risk factors include anthracyclines and chest-directed radiotherapy, but other therapies also pose cardiotoxic risks.
• Cardiometabolic factors and prior toxicities exacerbate CVT risk in CCSs.

Purpose of the Study:

• To review current risk stratification strategies for CTR-CVTs in CCSs.
• To propose a tailored, multimodal approach for cardio-oncological assessment during and after cancer treatment.
• To highlight the role of echocardiography in managing long-term cardiovascular complications.

Main Methods:

• Systematic review of existing literature and international recommendations.
• Analysis of risk factors associated with CTR-CVTs.
• Development of a proposed framework for risk assessment and management.

Main Results:

• Identified key anticancer therapies and clinical conditions contributing to CTR-CVT risk.
• Summarized current approaches to risk stratification for CTR-CVTs.
• Proposed a structured, multimodal cardio-oncological assessment protocol.

Conclusions:

• A proactive, tailored approach is crucial for managing CTR-CVT risk in CCSs.
• Early detection and personalized management strategies can mitigate long-term cardiovascular complications.
• Further validation of the proposed assessment approach is needed to optimize patient outcomes.