Long-term neurocognitive and behavioral outcomes in survivors of pediatric brain tumors: a systematic review

Background: Brain tumors are among the most common neoplasms in children. These patients suffer from neurocognitive impairment, treatment-related side effects, and experience a subpar quality of life (QoL), affecting academic endeavors, social interaction, and mental wellbeing. Methods: This review investigated different long-term neurocognitive and behavioral outcomes in pediatric brain tumor survivors and evaluated various effective treatment methods. We identified 75 relevant articles published between 2019 and 2024 using PubMed, PMC, Embase, and Google Scholar databases. Duplicates were removed, and 14 studies were finally selected following the PRISMA guidelines. Initial observations noted significant variations in the study methodologies and inclusion criteria. Results: Our study showed that children treated with proton radiotherapy experienced better neurocognitive and academic results than those treated with photon radiotherapy. Cognitive abilities were affected irrespective of the treatment, especially in early stage radiotherapy. Psychosocial impacts such as low self-esteem, depressive symptoms, and increased suicidal ideation were also demonstrated. Improvement in long-term outcomes was noted within therapeutic plans devoid of delayed high-dose radiotherapy and marrow ablation chemotherapy. Discussion: Increasing our understanding of the long-term effects associated with brain tumors using our current treatment methodology will help us formulate better treatment protocols and improve survivors' quality of life.