Long-Term Sequelae

Abstract

Over the last decades, the outcome of children with central nervous system tumors has significantly improved. The latest data from the Surveillance Epidemiology and End Results estimated that 74 % of children with brain tumors survive beyond 5 years. However as those survivors become young adults, the incidence of late effects is being more apparent.

More than two third 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 survivor of childhood CNS tumors. There is an estimated increase risk of 40- to 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 suffers from neurological and neurosensory sequelae such as epilepsy in 25 % and coordination problem 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. 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 for the next decades.