Which therapy is most closely linked to the risk of cardiomyopathy and arrhythmias in pediatric cancer survivors?

Which therapy is most closely linked to the risk of cardiomyopathy and arrhythmias in pediatric cancer survivors?

• A. Anthracycline use
• B. Cranial irradiation
• C. Cisplatin
• D. Antimetabolites

Answer: (A)

Anthracyclines are the therapy most closely linked to risk of cardiomyopathy and arrhythmias in pediatric cancer survivors. Doxorubicin, daunorubicin, and related drugs cause heart injury that is strongly dose-dependent and can appear years after treatment. The damage stems from oxidative stress and free radical formation in heart muscle cells, mitochondrial dysfunction, and interference with cardiac DNA through topoisomerase II beta, leading to progressive dilated cardiomyopathy and potential rhythm disturbances. Risk increases with higher cumulative doses and is greater in younger children, females, those who also receive chest irradiation, or those with preexisting heart conditions. Because of this, survivors are routinely monitored with cardiac imaging, and protective strategies (like limiting dose or using dexrazoxane in select cases) are considered to reduce the risk. In comparison, cranial irradiation is linked more to endocrine and neurocognitive effects, while cisplatin and antimetabolites have toxicities that do not predominantly involve late cardiomyopathy and arrhythmias.

Anthracyclines are the therapy most closely linked to risk of cardiomyopathy and arrhythmias in pediatric cancer survivors. Doxorubicin, daunorubicin, and related drugs cause heart injury that is strongly dose-dependent and can appear years after treatment. The damage stems from oxidative stress and free radical formation in heart muscle cells, mitochondrial dysfunction, and interference with cardiac DNA through topoisomerase II beta, leading to progressive dilated cardiomyopathy and potential rhythm disturbances. Risk increases with higher cumulative doses and is greater in younger children, females, those who also receive chest irradiation, or those with preexisting heart conditions. Because of this, survivors are routinely monitored with cardiac imaging, and protective strategies (like limiting dose or using dexrazoxane in select cases) are considered to reduce the risk. In comparison, cranial irradiation is linked more to endocrine and neurocognitive effects, while cisplatin and antimetabolites have toxicities that do not predominantly involve late cardiomyopathy and arrhythmias.