Endocrine Abstracts

In the last 50 years survival after childhood cancer has dramatically improved. However, childhood cancer survivors (CCS) are at risk for a considerable array of late effects arising from previous anti-cancer therapies. The excess mortality (compared with the general population) in CCS is mostly due to second neoplasms and cardiovascular diseases. Indeed, the cardiovascular system has been recognized as a highly sensitive target for damage by anti-cancer therapies. Early in the study of late effects, the anthracyclines were identified as a cause of late-onset myocardial dysfunction, with a dose-dependent mechanism. Moreover, radiotherapy was widely used in treatment protocols of several paediatric cancer (e.g. Hodgkin disease) but all components of the heart (pericardium, myocardium, valves and conduction system, as well as artery wall) are susceptible to ionizing radiations. Hence it follows that CCS treated with chest radiotherapy have a high risk of coronary artery disease, but also of valvular abnormalities, arrhythmias and stroke. Furthermore, several studies reported that CCS are more likely to have additional risk factors (dyslipidaemia, hypertension, diabetes). CCS, in general, are twice as likely to be hypertensive or diabetic as their siblings, with higher prevalence of these conditions in patients treated with abdominal radiotherapy or bone marrow transplantation. Obesity is a well known late effects in survivors of central nervous system tumours (due to hypothalamic damage or reduced physical activity). In conclusion, CCS need a long-term follow-up to manage this cardiovascular risk, in accordance with the growing evidences on this field and recommendations proposed by international cancer survivorship institutions.