Long-Term Sequelae

Over the past several decades, the survival outcomes of children with central nervous system tumors have significantly improved. The latest data from the Surveillance Epidemiology and End Results estimated that 84% of children with brain tumors survive beyond 5 years. However, as those survivors become young adults, the incidence of late effects is becoming more apparent. More than two thirds of long-term survivors have at least one chronic medical problem. These sequelae include endocrine and metabolic late effects such as hypogonadism and thyroid disorders. This risk depends upon the location of the tumor and the treatment modalities that were used. A growing body of literature reports cerebrovascular disease in survivors of childhood CNS tumors. There is an estimated increased risk of 40–100-fold of late-occurring stroke and transient ischemic attack with a cumulative incidence of 7% at 25 years. Subsequent neoplasm is also a major concern and affects approximately 10% of survivors at 25 years posttreatment. Furthermore, a significant percentage of survivors suffer from neurological and neurosensory sequelae such as seizures in 20% and coordination problems in almost half of the survivors of childhood brain tumors. Ototoxicity is one of the most common persistent side effects of chemotherapy with platinum-based regimen or irradiation therapy of the posterior fossa. Other long-term sequelae include osteoporosis, dental problems, sleep disorders, peripheral neuropathy, visual impairment, and neurocognitive and psychosocial impacts. To address their specific medical, psychological, and social needs, multidisciplinary and comprehensive clinics are essential. Reduction in long-term side effects without compromising survival will be a significant challenge over the next decades.