PEDIATRIC CLINICS AMSTERDAM Cardioprotective interventions for cancer patients receiving anthracyclines: a Cochrane systematic review

Anthracyclines have gained widespread use in the treatment of numerous malignancies in both adults and children. Unfortunately, their use is limited by the occurrence of cardiac damage. The precise mechanism underlying this is still not fully understood, but a major role has been ascribed to free radical generation by anthracycline-iron complexes. The heart is particularly vulnerable to free radical injury because protective enzymes such as superoxide dismutase are present at a lower level in heart tissue than in other tissues. The cardiac damage can become manifest as either clinical heart failure or asymptomatic cardiac dysfunction, which may not only develop during anthracycline therapy, but also years after the cessation of treatment. The risk of developing heart failure therefore remains a lifelong threat, especially to children who have a long life-expectancy after a successful antineoplastic treatment. In the literature the frequency of clinical heart failure has been reported to be as high as 16% and that of asymptomatic cardiac dysfunction to be more than 57%. Several risk factors, such as a higher cumulative anthracycline dose, cardiac radiotherapy and female gender, have been identified, although not conclusively in all studies. In an effort to prevent or reduce cardiac damage, PEDIATRIC CLINICS AMSTERDAM