Exercise Intolerance And Cardiac Dysfunction Following Treatment For Intracranial And Craniospinal Tumors In Childhood

Objective

State-of-the-art therapy improves the five-year survival rate of patients under the age of 20 with cranial and craniospinal tumors up to 74 %. We aimed to assess echocardiographic parameters and exercise performance in subjects following complex treatment for cranial and craniospinal tumors in childhood.

Methods

48 subjects who underwent cranial and craniospinal irradiation for CNS tumors in childhood were compared to 20 healthy controls. Examination included cardiopulmonary exercise testing (CPET), hormone studies and echocardiography.

Results

According to CPET parameters cancer survivors showed significantly impaired exercise tolerance compared to healthy volunteers resulting in lower peak VO₂ (19.8 vs 30.3 ml*min/kg; p<0.001), lower percent from predicted peak VO₂ (58.6% vs 85.8%; p<0.001) and lower ventilatory efficacy (VE/VCO₂ 29.9 vs 23.6; p=0.044; peak PetCO₂ 36.3 vs 40.6 mm Hg; p=0.009). Poor exercise tolerance was associated with a younger age at the time of treatment initiation. 5 patients from the main group (10.4%) demonstrated abnormal echocardiographic parameters including thickening and calcification of the aortic valve leaflets and diffuse reduction in the systolic LV and RV function. Hormonal derangements like somatotropin insufficiency, hypocorticism, hypothyroidism, hypogonadism in cancer survivors correlated both with exercise intolerance and echocardiographic abnormalities.

Conclusion

Exercise intolerance and cardiac dysfunction coupled with hormonal deficits are not uncommon among patients following treatment for intracranial and craniospinal tumors at a young age. Obtained data confirms the importance of regular cardiovascular risk assessment in childhood cancer survivors.