Early Diagnosis and Cardiovascular Risk Stratification in Children Exposed to Cancer Therapies

How to Improve Early Diagnosis and Cardiovascular Risk Stratification in Children Exposed to Chemotherapy and/or Thoracic Radiotherapy? Multimodal Cardiological Evaluation and Biomarkers.

The goal of this prospective interventional study is to improve the detection of subclinical chronic Cancer Therapy-Related Cardiovascular Toxicity (CTRCT) and evaluate the added value of advanced cardioechography, ergospirometry, and specific biomarkers in pediatric cancer survivors (aged 2 to 25) who received potentially cardiotoxic treatments (chemotherapy/thoracic radiotherapy). The main questions it aims to answer are:

• Can advanced echocardiography (including strain and myocardial work), ECG, and ergospirometry effectively diagnose earlier subclinical cardiac impairment in this population?
• What is the prevalence of cardiovascular risk factors (including physical activity levels and biological markers like proBNP/troponins)
• Can new genetic or biological markers be identified to help optimizing the detection of CTRCT?

At time of follow-up, if they agree, participants will:

• Complete validated questionnaires regarding quality of life, physical activity, and sedentary behavior.
• Undergo a cardiopulmonary exercise test (ergospirometry) for those aged over 8 years.
• Wear an accelerometer (ActiGraph GT3X) for 7 consecutive days to monitor physical activity.
• Provide an additional blood sample during routine follow-up for the creation of a biobank dedicated to analyzing markers of senescence, fibrosis, apoptosis, and genetic polymorphisms.

Inclusion Criteria:

• History of chemotherapy and/or radiotherapy for an oncological condition or bone marrow transplantation (hematologic disease) after 01/01/2016.
• Age < 18 years at the time of treatment.
• Cancer remission for more than one year.
• Voluntary participation following comprehensive informed consent.
• Signed informed consent from the patient (≥ 18 years) or from parents/legal guardians, with signed assent for minors aged 8 to 17.

Exclusion Criteria:

• Active disease recurrence or relapse.
• Current administration of antineoplastic therapy.
• Withdrawal of consent or refusal to participate by the patient or their legal representatives.