Cognitive deficiency following childhood cranial radiation therapy for brain tumors

Cognitive dysfunction is a common and disabling sequela of the multimodal treatment of brain tumors in children. Although its etiology is multifactorial and complex, cranial radiotherapy is a major factor. Younger children are most susceptible to cognitive impairment; treatment effects become magnified with a more immature central nervous system. Treatment strategies aimed at reducing the incidence and severity of cognitive deficiency in children <3 include radiotherapy dose reduction, preirradiation chemotherapy, and primary chemotherapy. A new strategy being investigated is hyper-fractionated radiotherapy. With all treatment approaches, a balance must be struck between disease control and reduction of treatment morbidity—particularly cognitive decline.