Medical and neurocognitive late effects among survivors of childhood central nervous system tumors

Abstract

Received June 26, 2001; accepted August 21, 2001. Primary brain and other central nervous system (CNS) tumors are the most common solid tumors that occur during childhood, with an annual U.S. rate of approximately 3.0 cases per 100,000 persons aged 19 years or younger. Incidence rates of pediatric CNS malignancies were essentially unchanging during the 1990s; past concerns about trends that indicated increasing rates in the 1980s appears to be largely explainable by diagnostic and ascertainment improvements that occurred during that time period. The prevalence of persons alive with a previous diagnosis of a CNS malignancy is estimated by the National Cancer Institute to be 35 per 100,000 males and 29 per 100,000 females. Because nonmalignant CNS tumors (such as meningiomas) are not included in this statistic, the actual prevalence of CNS tumor survivors in the U.S. is substantially higher than the National Cancer Institute estimates. As treatment improves, more children are surviving cancer into adulthood. Survival rates for those with pediatric CNS tumors differ substantially by histology, site, and age at diagnosis. Overall, the 5-year survival probability for children with a CNS malignancy diagnosed between 1985 and 1994 was 67%. Pediatric patients generally have a better prognosis than adults with CNS tumors, although the morbidity from these tumors and their treatment can be substantial. As more children with CNS tumors survive and require treatment in primary care settings, it is increasingly important for health care providers to recognize long-term complications of these tumors and their treatments. The purpose of this article is to provide a concise review of the long-term effects of pediatric CNS tumors and their treatment. We hope this review will aid providers in managing CNS survivors’ existing problems and in anticipating problems that survivors may face.