Central nervous system (CNS) cancers are the second most common cancer in children in the United States, representing just over 20% of all malignancies during childhood.1 In 2010, there were 4,030 new cases of pediatric brain and other CNS tumors in children between the ages of 0-19, including 2,880 who were younger than 15 years.2 Incidence rates are slightly higher in males when compared to females, and slightly higher among white children when compared to black children.3
Mortality following a diagnosis of a CNS tumor in childhood continues to decline. The five year survival rate among those 0-19 years of age now approaches 75%, up from 58% in 1977.3 Survival does not differ by sex or race.4 In a study by Mariotto et al (2009), it was estimated that there were 51,650 survivors of childhood brain cancers as of January 2005 in the United States.5
Most Common Pediatric Brain Tumors
There are more than 100 different types of brain tumors in children, but the majority of tumors diagnosed include medulloblastoma, primitive neuroectodermal tumor (PNET), ependymoma and gliomas.6 Location and histology of each tumor help to predict tumor behavior and guide treatment.6 Table I summarizes the most common tumor types by location, and indicates the tumors’ distribution among all childhood CNS cancers.
Treatment options and their late effects
There are three components of treatment for brain tumors: chemotherapy, surgery and radiation.7 Patients with medulloblastoma and astrocytoma usually receive a combination of modalities to treat the tumor.6 These modalities are known to cause significant medical and physical late effects into survivorship. Neurocognitive and functional limitations could be caused by direct neurologic damage caused by the tumor and its removal, the long-term toxicity of chemotherapy, and/or the effects of radiation on the developing nervous system. 8-10
Generally the first form of treatment and essential for early management, surgical resection is necessary to establish a diagnosis, relieve hydrocephalus, and achieve maximal tumor resection.7,11-13 Surgery is generally safe in reducing tumor size.6 Survival and quality of life have improved due to gross total resection in children with cerebellar tumors.14
Late Effects of Surgery
Effective as it may be, surgery is not without cost. It may cause significant late effects that may reduce quality of life and hinder physical function into survivorship. In a recent report by Küpeli et al (2011), 25% of children who underwent surgery for tumor resection in the posterior fossa developed loss of speech associated with decreased muscle tone, unsteadiness, emotional labiality and irritability, or posterior-fossa mutism syndrome.15 Common complications of posterior fossa tumor surgery include long tract deficits, hemiparesis, sensory abnormalities, deep venous thrombosis, and pulmonary embolism.16 Sensory abnormalities, along with those other complications, could...