The neurodevelopmental price of survival in children with malignant brain tumours

Area of Science:

• Pediatric Oncology
• Neuroscience
• Quality of Life Research

Background:

• Improving survival rates for malignant brain tumors in children has shifted focus to long-term side effects.
• Neurocognitive and neurobehavioral disorders are significant sequelae affecting survivors' quality of life, often exacerbated by academic and social challenges.

Purpose of the Study:

• To highlight the persistent challenges in quality of life for long-term survivors of pediatric malignant brain tumors.
• To emphasize the need for serial neuropsychological and behavioral evaluations, incorporating patient-reported outcomes.
• To advocate for interdisciplinary treatment protocols that balance maximizing survival with minimizing cognitive and behavioral deficits.

Main Methods:

• Review of existing literature on the side effects of malignant brain tumor treatments in children.
• Analysis of the impact of radiotherapy (CRT), intrathecal methotrexate, and surgical approaches on neurocognition and behavior.
• Discussion of the necessity for comprehensive evaluations considering various clinical factors.

Main Results:

• Radiotherapy (CRT), even with dose reductions and hyperfractionation, negatively impacts cognitive function.
• Intrathecal methotrexate causes severe cognitive impairment, which is amplified when combined with CRT.
• Certain surgical techniques can lead to postoperative behavioral disturbances.

Conclusions:

• Despite treatment advancements, pediatric brain tumor survivors face significant neurocognitive and behavioral deficits.
• Comprehensive, serial evaluations including patient perspectives are crucial.
• Interdisciplinary treatment strategies are essential to improve long-term quality of life by minimizing treatment-related deficits.