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Open Access 01-12-2023 | Echocardiography | Research

Acute and early-onset cardiotoxicity in children and adolescents with cancer: a systematic review

Authors: Theodorus W. Kouwenberg, Elvira C. van Dalen, Elizabeth A. M. Feijen, Stejara A. Netea, Melissa Bolier, Martijn G. Slieker, Firdaus A. A. Mohamed Hoesein, Leontien C. M. Kremer, Heynric B. Grotenhuis, Annelies M. C. Mavinkurve-Groothuis

Published in: BMC Cancer | Issue 1/2023

Abstract

Background

Cardiotoxicity is among the most important adverse effects of childhood cancer treatment. Anthracyclines, mitoxantrone and radiotherapy involving the heart are its main causes. Subclinical cardiac dysfunction may over time progress to clinical heart failure. The majority of previous studies have focused on late-onset cardiotoxicity. In this systematic review, we discuss the prevalence and risk factors for acute and early-onset cardiotoxicity in children and adolescents with cancer treated with anthracyclines, mitoxantrone or radiotherapy involving the heart.

Methods

A literature search was performed within PubMed and reference lists of relevant studies. Studies were eligible if they reported on cardiotoxicity measured by clinical, echocardiographic and biochemical parameters routinely used in clinical practice during or within one year after the start of cancer treatment in ≥ 25 children and adolescents with cancer. Information about study population, treatment, outcomes of diagnostic tests used for cardiotoxicity assessment and risk factors was extracted and risk of bias was assessed.

Results

Our PubMed search yielded 3649 unique publications, 44 of which fulfilled the inclusion criteria. One additional study was identified by scanning the reference lists of relevant studies. In these 45 studies, acute and early-onset cardiotoxicity was studied in 7797 children and adolescents. Definitions of acute and early-onset cardiotoxicity prove to be highly heterogeneous. Prevalence rates varied for different cardiotoxicity definitions: systolic dysfunction (0.0–56.4%), diastolic dysfunction (30.0–100%), combinations of echocardiography and/or clinical parameters (0.0–38.1%), clinical symptoms (0.0–25.5%) and biomarker levels (0.0–37.5%). Shortening fraction and ejection fraction significantly decreased during treatment. Cumulative anthracycline dose proves to be an important risk factor.

Conclusions

Various definitions have been used to describe acute and early-onset cardiotoxicity due to childhood cancer treatment, complicating the establishment of its exact prevalence. Our findings underscore the importance of uniform international guidelines for the monitoring of cardiac function during and shortly after childhood cancer treatment.

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Title: Acute and early-onset cardiotoxicity in children and adolescents with cancer: a systematic review
Authors: Theodorus W. Kouwenberg
Elvira C. van Dalen
Elizabeth A. M. Feijen
Stejara A. Netea
Melissa Bolier
Martijn G. Slieker
Firdaus A. A. Mohamed Hoesein
Leontien C. M. Kremer
Heynric B. Grotenhuis
Annelies M. C. Mavinkurve-Groothuis
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Echocardiography
Echocardiography
Anthracycline
Mitoxantrone
Published in: BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-023-11353-9

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