The risk of cardiovascular disease in childhood cancers after survival was found to be 8-10 times higher than the control groups. Studies have shown that the risk of death from cardiovascular diseases increases significantly after 5-10 years following the completion of treatment, and it is the most important cause of mortality in patients given the diagnosis for more than 30 years. Therefore, regular follow-up of patients is required during and after treatment. For example, approximately half of patients who have been treated with anthracycline and whose treatment have been completed for more than 10 years ago have subclinical cardiac disease, even if no symptoms are present. Considering all patients after survival, this is over 25%. These results indicate that subclinical findings will worsen over the years. It is not always possible to predict the chemotherapy associated toxicity in children and how long-term  toxicity  will  result.  Chemotherapy-induced  changes,  such  as  loss  of  myocardial  function,  or  loss  of  vascular hemodynamics, as well as direct myocardial damage, may affect the cardiovascular system. The cardiovascular system is also susceptible to radiation damage. The main mechanism is the development of interstitial fibrosis. In patients undergoing treatment, diagnostic evaluation should be performed at regular intervals in order to obtain basal values related to the cardiovascular system and to detect early findings. In patients whose treatment have been completed, the generally accepted approach is to perform this evaluation every 5 years in asymptomatic patients and to determine the frequency according to symptoms and findings in symptomatic patients. In addition, new treatment protocols should be developed on the basis of determination of lowest effective dose, development of alternative dosage and application methods, addition of cardiac protective agents to protocols, reduction of the use and dose of radiotherapy to reduce disease incidence due to cardiac toxicity. Prevention of obesity, metabolic syndrome, hypertension and hyperlipidemia, follow-up of early atherosclerosis, caution in terms of arrhythmia, prevention of smoking, alcohol use and substance abuse are also important after survival.

Keywords: Cancer, Chemotherapy, Childhood, Radiotherapy, Toxicity