Cardiotoxicity in childhood cancer survivors: risk of low dose cancer treatment, added value of ECG in surveillance and prevention by dexrazoxane

Long-term health effects in the growing population of childhood cancer survivors are of major concern. Cardiac disease, because of treatment with anthracyclines, mitoxantrone or radiotherapy involving the heart region, can manifest as myocardial dysfunction and heart failure. Ten percent of the survivors exposed to cardiotoxic cancer treatment will develop this within 40 years after their cancer diagnosis. Heart failure is currently the most common non-cancer-related cause of mortality in survivors and significantly compromises the quality-of-life. This thesis delves into the current state of cardiac diseases in childhood cancer survivors (Chapter 2) and presents new insights into risk stratification, early detection, and primary cardioprotection of cardiac dysfunction and heart failure. Risk stratification studies demonstrated that high doses of cardiotoxic treatments increase the risk of heart failure, but limited evidence existed about risks associated with lower doses. Chapter 3 describes a study involving over 30,000 European childhood cancer survivors that demonstrated a 2% prevalence of heart failure by age 50. Recent decades' survivors had lower heart failure mortality. Additionally, investigations into lower doses of chemotherapy and radiotherapy showed that even survivors exposed to low mean heart radiotherapy doses (5-