小児期がん治療の心臓に対する代償は大きい（Abstract 10400, Poster 2186）

小児期がんサバイバーは動脈が変化しておりそれが若年性心疾患や動脈硬化のリスクを上昇させる可能性がある
Childhood cancer survivors have changes in their arteries that may increase their risks of early heart disease and atherosclerosis
小児がん治療は小児がんサバイバーの心臓を犠牲にするとの研究結果が2013年American Heart Association学会で発表された。過去の研究から、小児がんサバイバーは治療から数十年後に心臓および他の健康上の問題に直面することが示されている。しかし今回、患者がまだ小児の間に生じる小児がん治療の心血管系への影響が初めて観察された。研究者らは白血病および固形がんのサバイバーである男女（9～18歳）319人において動脈スティフネス、壁厚、および機能を計測した。参加者は初回のがん診断から5年以上生存した。がんサバイバーをがんと診断されていない彼らの兄弟姉妹208人と比較した結果、動脈機能低下で示される早期心疾患が小児がんサバイバーにおいて多く認められた。さらに、化学療法終了後の小児白血病患者は、がんでない群と比較し動脈の健康状態が9%低下していた。今回のスタディの対象となった小児は主に白人であり、したがって今回の結果は他の人種や民族には当てはまらない可能性がある。小児がんサバイバーは心血管リスクを低下させるための生活習慣改善を行うべきである、と筆者らは述べている。
Full Text

Cancer treatment takes a toll on the hearts of child survivors, according to research presented at the American Heart Association's Scientific Sessions 2013.
"Research has shown childhood cancer survivors face heart and other health problems decades after treatment," said Donald R. Dengel, Ph.D., study lead author and a kinesiology professor at the University of Minnesota in Minneapolis. "But researchers had not — until now — looked at the cardiovascular effects of childhood cancer treatment while survivors are still children."

Dengel and colleagues measured artery stiffness, thickness and function in 319 U.S. boys and girls (ages 9-18) who had survived leukemia or cancerous tumors. Participants had survived 5 years or longer since their initial cancer diagnosis. Comparing the survivors to 208 sibling children not diagnosed with cancer, researchers found:

  • Premature heart disease, as demonstrated by a decline in arterial function, was more likely among the children who survived cancer.
  • Childhood leukemia survivors had a 9 percent decrease in arterial health after completing chemotherapy compared to the non-cancer group.

"Given this increased risk, children who survive cancer should make lifestyle changes to lower their cardiovascular risk," Dengel said. "Healthcare providers who are managing chemotherapy-treated childhood cancer survivors need to monitor cardiovascular risk factors immediately following the completion of their patients' cancer therapy."

The children in the study were predominately white, so the findings might not apply to other racial and ethnic groups, Dengel said.

"And because of differences in childhood cancer treatment protocols, we are unable to attribute the changes in vascular structure and function to a specific chemotherapy agent," he said.

Co-authors are Aaron S. Kelly, Ph.D.; Lei Zhang, Sc.M.; James S. Hodges, Ph.D.; K. Scott Baker, M.D., M.S.; and Julia Steinberger, M.D., M.S. Author disclosures are on the abstract.

The National Institutes of Health, National Center for Research Resources and General Clinical Research Center Program funded the study.