Subsequent neoplasms of the CNS among survivors of childhood cancer: a systematic review.

Area of Science:

• Oncology
• Neuro-oncology
• Radiation Oncology

Background:

• Childhood cancer survivors are at increased risk for subsequent central nervous system (CNS) neoplasms.
• Understanding incidence, risk factors, and outcomes is crucial for developing informed screening guidelines.

Purpose of the Study:

• To determine the risk of CNS tumors after cranial radiation for pediatric cancer compared to the general population.
• To evaluate outcomes in children with subsequent CNS neoplasms following CNS-directed radiation.
• To compare outcomes of subsequent CNS neoplasms with primary neoplasms of similar histology.

Main Methods:

• Systematic literature search of Medline and Embase (1966–2012).
• Inclusion of 18 reports from 72 identified studies.
• Analysis focused on risk, outcomes, and comparison with primary neoplasms.

Main Results:

• Childhood cancer survivors exhibit an 8.1-52.3 times higher incidence of subsequent CNS neoplasms than the general population.
• Cranial radiation exposure was linked to nearly all subsequent CNS neoplasms, with a potential dose-response correlation.
• Five-year survival for subsequent high-grade gliomas (0–19.5%) and meningiomas (57.3–100%) mirrored rates for primary tumors.

Conclusions:

• Childhood cancer survivors treated with cranial radiation therapy have a substantially elevated risk of developing subsequent CNS neoplasms.
• Evidence quality is limited by study design, heterogeneity, follow-up duration, and sample size.
• The current literature does not support or refute the benefits and harms of routine screening for subsequent CNS neoplasms.