Late effects of cancer treatment: consequences for long-term brain cancer survivors

Abstract

Late adverse effects of cancer treatments represent a significant source of morbidity and also financial hardship among brain tumor patients. These effects can be produced by direct neurologic damage of the tumor and its removal, and/or by complementary treatments such as chemotherapy and radiotherapy, either alone or combined. Notably, young adults are the critical population that faces major consequences because the early onset of the disease may affect their development and socioeconomic status. The spectrum of these late adverse effects is large and involves multiple domains. In this review we classify the main long-term adverse effects into 4 sections: CNS complications, peripheral nervous system complications, secondary neoplasms, and Economic impact. In addition, CNS main complications are divided into nonfocal and focal symptoms. Owing to all the secondary effects mentioned, it is essential for physicians to have a high level of clinical suspicion to prevent and provide early intervention to minimize their impact.

Keywords: adverse events; brain tumors; glioma; long-term survivors; metastases.

Fig. 1

A, Leukoencephalopathy induced by whole-brain radiotherapy. T2/fluid-attenuated inversion recovery MRI showing hyperintensities affecting bilateral subcortical white matter. B, Radio-induced cavernomas and meningeal siderosis in an adult patient with a medical history of glioma World Health Organization grade I treated with radiotherapy in his childhood. T2-weighted gradient-echo MRI sequence. C, Cerebral radiation necrosis (focal area of contrast-enhancement on T1-weighted MRI) with lower relative cerebral blood volume levels, D, in a patient treated with radiosurgery for brain metastasis; and the histopathological findings after surgical resection, showing astrogliosis, infiltration by macrophages, necrosis, hyalinosis, and extensive vasculopathic changes that include E, ectasia, fibrinoid necrosis, and obliterative mural fibroplasia. F, SMART (stroke-like migraine attacks after radiation therapy) syndrome from a patient showing diffuse unilateral cortical T1-weighted gadolinium enhancement of cerebral gyri during the acute neurological event. G, Radiation-induced optic neuropathy of a patient with pituitary metastasis treated with stereotactic radiosurgery. Contrast-enhancement on T1-weighted MRI showing focal enhancement of both intracranial optic nerves. H, Radiation-induced meningioma.