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Published on: October 18, 2011
Neurocognitive outcome in survivors of pediatric cancer
1University of Texas Southwestern Medical Center, Dallas, Texas, USA. Naomi.winick@utsouthwestern.edu
Insights
Pediatric cancer survivors, especially those treated for central nervous system (CNS) tumors, face neurocognitive challenges. Research explores understanding and mitigating these effects through advanced imaging, animal models, and cognitive training.
Area of Science:
- Pediatric oncology
- Neuroscience
- Cancer survivorship
Background:
- Over 11 million pediatric cancer survivors reside in the US.
- Survivors of leukemia and central nervous system (CNS) tumors are disproportionately affected by cancer and its treatments.
- Neurocognitive dysfunction is a significant long-term consequence for these survivors.
Purpose of the Study:
- To review the neurocognitive outcomes in pediatric survivors of leukemia and CNS tumors.
- To explore the pathophysiology of treatment-related neurocognitive dysfunction.
- To outline strategies for ameliorating neurocognitive deficits.
Main Methods:
- Review of existing literature on neurocognitive outcomes in pediatric cancer survivors.
- Analysis of the impact of chemotherapy and radiation therapy on neurocognition.
- Discussion of emerging research including advanced imaging techniques and animal models.
Main Results:
- Chemotherapy's impact on leukemia survivors without radiation is understood.
- Differential effects of radiation fields and doses on CNS tumor survivors are described.
- Newer imaging and animal models show promise for predicting and mitigating neurotoxicity.
Conclusions:
- Pediatric cancer treatment, with or without cranial radiation, leads to neurocognitive consequences.
- Animal models and advanced imaging techniques offer insights into neurotoxicity.
- Cognitive training programs, including home-based computerized options, may help minimize long-term effects.
Purpose Of Review:
There are more than 11 million survivors of pediatric cancers living in the US. The largest proportion had leukemia and the group most severely impacted by their cancer and their therapies are the survivors of central nervous system (CNS) tumors. This review describes the neurocognitive outcome for these groups and outlines work aimed at understanding the pathophysiology of and approach to ameliorating neurocognitive dysfunction.
Recent Findings:
The impact of chemotherapy on children treated for leukemia without radiation has been elucidated and the differential impact of different radiation fields and doses among children with CNS malignancies has been described. Newer imaging techniques may predict damage earlier and animal models of chemotherapy-induced neurotoxicity may prove valuable in designing less toxic therapies or finding protective agents. Cognitive training programs, notably computerized programs that can be accessed at home, may be part of successful programs for minimizing neurotoxicity.
Summary:
This review seeks to describe the neurocognitive consequences of cancer and its therapy among pediatric patients treated for leukemia or a CNS tumor. The consequences of therapy with and without cranial radiation are described and information on potentially valuable animal models and imaging techniques are presented. The impact of host pharmacogenomics is outlined.
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