Review: Neurological Complications From Therapies for Pediatric Brain Tumors

Abstract

Surgery, chemotherapy and radiation have been the mainstay of pediatric brain tumor treatment over the past decades. Recently, new treatment modalities have emerged for the management of pediatric brain tumors. These therapies range from novel radiotherapy techniques and targeted immunotherapies to checkpoint inhibitors and T cell transfer therapies. These treatments are currently investigated with the goal of improving survival and decreasing morbidity. However, compared to traditional therapies, these novel modalities are not as well elucidated and similarly has the potential to cause significant short and long-term sequelae, impacting quality of life. Treatment complications are commonly mediated through direct drug toxicity or vascular, infectious, or autoimmune mechanisms, ranging from immune effector cell associated neurotoxicity syndrome with CART-cells to neuropathy with checkpoint inhibitors. Addressing treatment-induced complications is the focus of new trials, specifically improving neurocognitive outcomes. The aim of this review is to explore the pathophysiology underlying treatment related neurologic side effects, highlight associated complications, and describe the future direction of brain tumor protocols. Increasing awareness of these neurologic complications from novel therapies underscores the need for quality-of-life metrics and considerations in clinical trials to decrease associated treatment-induced morbidity.

Communication, academic and social outcomes of childhood cancer survivors with hearing loss: A systematic review

“…This may reflect that CNS cancer survivors have higher rates of neurocognitive difficulties, which are significantly associated with poorer academic and social outcomes. 29,33 Additionally, neurocognitive difficulties may be more prevalent in CCS with treatment-induced HL compared with CCS without HL. 30,59,60,[62][63][64] Future large and wellcontrolled studies comparing hearing acuity, as well as communication and neurocognitive outcomes both before and at more than one time point after cancer treatment, would be ideal to clarify the additional short-and long-term impact of treatment-induced HL for CCS.…”

“…However, more studies about children with CNS tumours reported significantly poorer performance in reading, perceived school functioning and peer interactions than studies encompassing any type of cancer. This may reflect that CNS cancer survivors have higher rates of neurocognitive difficulties, which are significantly associated with poorer academic and social outcomes 29,33 . Additionally, neurocognitive difficulties may be more prevalent in CCS with treatment‐induced HL compared with CCS without HL 30,59,60,62–64 .…”

“…However, this evidence may not accurately elucidate the support needs of CCS with treatment‐induced HL who likely had normal hearing before cancer treatment. CCS often experience physical, cognitive and psychological late effects of treatment, which could compound or coincide with the impacts of treatment‐induced HL 28–31 . CCS may also experience barriers to timely diagnosis and effective audiological management due to medical issues, 32–34 and the emergence or worsening of HL years after cancer treatment 4,35,36 …”

“…of treatment, which could compound or coincide with the impacts of treatment-induced HL. [28][29][30][31] CCS may also experience barriers to timely diagnosis and effective audiological management due to medical issues, [32][33][34] and the emergence or worsening of HL years after cancer treatment. 4,35,36 Greater clarity about HL impacts specific to CCS can help holistically understand the support needs after cancer.…”

Impact of tumour characteristics and cancer treatment on cerebrovascular mortality after glioma diagnosis: Evidence from a population-based cancer registry

“…However, this number may be under reported and not reflect the true burden of this disease, because in patients with a brain tumour a cerebrovascular event may not be considered as a cause of clinical deterioration. Prompt diagnosis of cerebrovascular diseases, including stroke is needed to achieve maximal functional recovery, and quality of life (36). This is especially important for patients with GBM where life expectancy is short.…”