Abstract
Neurocognitive disorders are a common long-term effect in brain tumor survivors. The rate of intelligence quotient (IQ) decline is associated with a several risk factors, including tumor location, younger age at time of treatment, treatment intensity, in particular use of radiotherapy and radiotherapy dose, as well as clinical variables such as hydrocephalus and presence of epilepsy. Demyelinization represents the most important alteration following radiation: loss of cerebral white matter is related to IQ decline, due to damage of the complex information transmission network connecting the various brain areas.Recently, combined chemo-radiotherapeutic approaches and new technologies in radiation therapy have enabled to lower the frequency of neurocognitive deficits and improve the quality of life of paediatric brain tumours survivors.
Highlights
Tumours of the central nervous system (CNS) are the most common form of solid tumours in childhood, accounting for 20 % of all pediatric malignancies [1, 2]
Most children who have survived brain tumours have required surgery and focal or craniospinal irradiation (CSI), with or without systemic chemotherapy . [4,5,6,7] The improvement in the effective therapy of childhood CNS tumors has resulted in a substantial increase in cure
[12] Subsequently, Reddick et al showed that decrease in the volume of cerebral white matter in patients with medulloblastoma underwent CSI was more rapid in patients receiving 36 Gy than in patients receiving 23.4 Gy craniospinal irradiation . [43]
Summary
Tumours of the central nervous system (CNS) are the most common form of solid tumours in childhood, accounting for 20 % of all pediatric malignancies [1, 2]. Embryonal tumours and low-grade gliomas are the most common brain tumors in children, followed by high-grade glioma, brainstem glioma and ependymoma [3]. There are two peaks in the incidence of brain tumours in children and adolescents. Most children who have survived brain tumours have required surgery and focal or craniospinal irradiation (CSI), with or without systemic chemotherapy . [4,5,6,7] The improvement in the effective therapy of childhood CNS tumors has resulted in a substantial increase in cure. Neurocognitive disorders and sometimes severe disabilities have been documented in 40–100 % of long-term survivors . [8,9,10]
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