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Central Nervous System Injury and Neurobiobehavioral Function in Children With Brain Tumors: A Review of the Literature

Baron Nelson, Mary PhD; Compton, Peggy PhD; Patel, Sunita K. PhD; Jacob, Eufemia PhD; Harper, Ronald PhD

doi: 10.1097/NCC.0b013e31825d1eb0
Articles: Online Only

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.

Objectives: 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.

Implications for Practice: Nurses require knowledge of these issues when discussing treatment with families and with caring for long-term survivors.

Author Affiliations: Children’s Hospital Los Angeles, California (Dr Baron Nelson); School of Nursing, University of California, Los Angeles (Drs Baron Nelson, Compton, and Jacob); City of Hope, Duarte, California (Dr Patel); and Department of Neurobiology and David Geffen School of Medicine, University of California, Los Angeles (Dr Harper).

Dr Baron Nelson received funding support for this project from award no. F31NR011560 from the National Institute of Nursing Research and a grant from Alex’s Lemonade Stand Foundation.

The content is solely the responsibility of the authors and does not necessarily represent official views of the National Institute of Nursing Research or the National Institutes of Health.

The authors have no conflicts of interest to disclose.

Correspondence: Mary Baron Nelson, PhD, Department of Radiology, Mailstop #81, 4650 Sunset Blvd, Los Angeles, CA 90027 (

Accepted for publication April 30, 2012.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins