Some patients develop symptoms so severe that cardiac or cardio-pulmonary transplantations were necessary. Survivors of childhood cancer often face the troubling problem of late cardiotoxic effects, which can be progressive and disabling.

Dexrazoxane, a topoisomerase II inhibitor, may be cardio-protective by scavenging free radicals and preventing topoisomerase IIB-mediated DNA and mitochondrial damage. Co-administration of dexrazoxane with doxorubicin has been found to lower the incidence of cardiotoxicity.

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Akam-Venkata et al state that screening for risk factors such as age, sex, comorbidities, and lifestyle at the time of diagnosis and tailoring a treatment regimen to reduce the possibility of cardiotoxicity may be beneficial. Exercise and more healthful diets may also be beneficial.4

Last, orthopedic challenges often arise in patients presenting with osteosarcoma. The standard of care for osteosarcoma involves limb-salvage surgery, which can consist of allograft, arthrodesis, arthroplasty (modular endoprosthesis), autograft, or amputation.

Patients undergoing osteosarcoma treatment are often subject to infections because of a combination of resection, reconstruction, and chemotherapy. Radiation therapy, which is used in this setting, may halt bone growth, and lead to fibrosis and wound healing complications. There is a need for new treatment regimens that create fewer orthopedic complications when treating sarcomas, especially in the pediatric population.5

With near-constant advances in cancer therapy and increasing survival rates of those diagnosed with cancer, the need for therapies with lower incidence of severe long-term effects is imperative.

RELATED: Pembrolizumab Shows Activity Among Some Young Patients With Advanced Sarcoma

The survival rate in children and adolescents alone has jumped from about 50% in the 1970s to 80% in the modern setting. Adverse events observed in the growing population of sarcoma survivors highlights the increased need for new, safe treatments, as infertility, cardiotoxicity, and orthopedic complications may not be seen until years after the completion of therapy.

Once these adverse effects manifest, they are often irreversible. Studying the late effects of cancer treatment is therefore imperative.


  1. Lipshultz ER, Holt GE, Ramasamy R, Yechieli R, Lipshultz SE. Fertility, cardiac, and orthopedic challenges in survivors of adult and childhood sarcoma. Am Soc Clin Oncol Educ Book. 2017;37:799-806.
  2. Massarotti C, Scaruffi P, Lambertini M, Remorgida V, Del Mastro L, Anserini P. State of the art on oocyte cryopreservation in female cancer patients: a critical review of the literature. Cancer Treat Rev. 2017;57:50-7.
  3. Rinaldi VD, Hsieh K, Munroe R, Bolcun-Filas EM, Schimenti JC. Pharmacological inhibition of the DNA damage checkpoint prevents radiation-induced oocyte death. Genetics. 2017 Jun 2. doi: 10.1534/genetics.117.203455 [Epub ahead of print]
  4. Akam-Venkata J, Franco VI, Lipshultz SE. Late cardiotoxicity: issues for childhood cancer survivors. Curr Treat Options Cardiovasc Med. 2016;18(7):47.
  5. Taran SJ, Taran R, Malipatil NB. Pediatric steosarcoma: an updated review. Indian J Med Paediatr Oncol. 2017;38(1):33-43. doi: 10.4103/0971-5851.203513