儿童肿瘤心脏病学的进展与挑战

Advances and Challenges in Pediatric Cardio-oncology

恶性肿瘤与心血管疾病已成为当今社会危害人类健康的主要原因。肿瘤治疗方式的不断进步使患者生存期延长,而其带来的心血管毒性及危险因素也受到了广泛关注,肿瘤心脏病学逐渐成为了一门新兴发展的交叉学科。儿童肿瘤幸存者作为其中一个特殊的群体,其肿瘤疾病谱、治疗方式、心血管后遗症等各个方面与成人截然不同。虽已有多种针对蒽环类药物心脏毒性的防治措施,但大部分情况下,定期监测和早期干预仍是预防其发展为终末期心血管疾病的唯一有效方法。近年来,越来越多的疾病被证实存在个体的基因易感性,而且癌症治疗后可能产生的结局多种多样,因此采用一刀切的诊疗方法是不合适的。相反,建立多学科良好的工作关系,评估各种治疗的风险和益处,并规划适当的监测是儿童肿瘤心脏病学的最佳模式。然而,在现有的儿童和青少年人群中,支持性的循证医学证据和用药指南推荐非常有限,多中心、大规模的随机对照试验迫在眉睫。

Malignant tumor and cardiovascular disease have become the main culprit to human health nowadays.The progress of oncotherapy methods prolonged life expectancy of tumor patients,but its cardiovascular toxicity and risk factors have also been widely concerned at the same time,booming onco-cardiology as a new developing interdisciplinary subject.As a special group,childhood cancer survivors possess a totally different disease spectrum,therapeutic pattern,cardiovascular sequelae comparing with those of adults.Although there are various prevention and treatment measures for cardiotoxicity after anthracyclines therapy,in most cases,regular monitoring and early intervention are still the only effective ways to prevent its progression to end-stage cardiovascular disease.In recent years,individual gene susceptibility has been verified to exist in more and more diseases,plus,the possible outcomes after cancer treatment are various,so a one-size-fits-all approach is not appropriate.On the contrary,establishing a good multidisciplinary relationship,balancing the risks and benefits of various therapies,and planning appropriate surveillance are the best models for pediatric onco-cardiology.However,in the child and adolescent population,supportive evidence-based researches and medication guidelines are very limited.Thus,multi-center,large-scale randomized controlled studies and clinical trials are urgently needed.