Neuropsychological Outcomes of Children Treated for Brain Tumors

Abstract

Central nervous system (CNS) neoplasms are the most common solid tumors diagnosed in children. CNS tumors represent the leading cause of cancer death and cancer-related morbidity for children less than 20 years of age, although there has been a moderate increase in survival rates over the past several decades. The average survival at 5 years now nearly reaches 75%, and for some, non-malignant histology approximates 97% at 20 years from diagnosis. Neurological, cognitive, and neuropsychological deficits are the most disabling long-term effects of brain tumors in children. Childhood is a time of extreme brain sensitivity and the time of life in which most brain development occurs. Thus, the long-term toxicities that children treated for CNS tumors experience can affect multiple developmental domains and day-to-day functioning, ultimately leading to a poor quality of survival (QoS). We reviewed literature focusing on the risk factors for cognitive and neuropsychological impairment in pediatric patients treated for brain tumors with the aim of better understanding who is at major risk and what the best strategies for monitoring these patients are.

Keywords: CNS; adolescents; brain tumor; children; cognitive/neuropsychological outcomes; neurologic late effects; radiotherapy.

Figure 1

Potential complications of childhood cancer by organ system. Created with BioRender.com.

Figure 2

PRISMA flow diagram for selection of articles.

Figure 3

Interaction of multiple factors representing potential injury to the developing brain and leading to neurologic and cognitive/neuropsychological deficits. Ultimately, these late effects together are associated with disability in everyday activities and, therefore, with impaired Health-Related Quality of Life.

Figure 4

Timing suggested for baseline evaluation and subsequent follow-up assessments. At any time point, during treatment or after the end of therapy, a reassessment is recommended in the phase of transition to new schools or when new difficulties emerge. Created with Biorender.