Central nervous system injury and neurobiobehavioral function in children with brain tumors: a review of the literature.
BACKGROUND
Children with brain tumors present a complex set of factors when considering treatment decisions, including type and location of tumor and age of the child. Two-thirds of children will survive, but historically have had poorer neurocognitive and quality-of-life outcomes when compared with survivors of other childhood cancers. Delaying or forgoing cranial radiation completely is thought to lead to improved neurobiobehavioral outcomes, but there is still relatively little research in this area.


OBJECTIVE
The objectives of this study were to review and consolidate what is known about the effects of cranial radiation and chemotherapy on normal brain tissue and to synthesize that information relative to neurobiobehavioral findings in children with brain tumors.


METHODS
A literature search using PubMed and PsycINFO from 2000 to 2011 was done using a variety of terms related to childhood brain tumor treatment and outcome. A total of 70 articles were reviewed, and 40 were chosen for inclusion in the review based on most relevance to this population.


RESULTS
Both cranial radiation and certain chemotherapy agents cause damage to or loss of healthy neurons, as well as a decrease in the number of progenitor cells of the hippocampus. However, in general, children treated with chemotherapy alone appear to have less of a neurobiobehavioral impact than those treated with cranial radiation.


CONCLUSIONS
The trend toward delaying or postponing cranial radiation when possible may improve overall neurocognitive and quality-of-life outcomes.


CONCLUSIONS
Nurses require knowledge of these issues when discussing treatment with families and with caring for long-term survivors.
Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. mbnelson@chla.usc.edu
Mary
M
Baron Nelson
Peggy
P
Compton
Sunita K
SK
Patel
Eufemia
E
Jacob
Ronald
R
Harper
D001930:Brain Injuries / Q000209:etiology / Q000451:nursing*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000451:nursing* / Q000532:radiotherapy; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000451:nursing*; D002648:Child; D060825:Cognitive Dysfunction / Q000209:etiology / Q000451:nursing; D003147:Communication Disorders / Q000209:etiology / Q000451:nursing; D006801:Humans; D008569:Memory Disorders / Q000209:etiology / Q000451:nursing; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors