Neurocognitive Outcomes in Pediatric Cancer Survivorship

Advances in diagnosis and treatment have led to markedly improved survival rates in childhood cancers, yet many survivors experience lasting neurocognitive challenges. These late effects encompass deficits in attention, processing speed, working memory and executive functions, often together with declines in overall intellectual ability. Neuroimaging studies reveal treatment-related alterations in both grey and white matter, influenced by factors such as age at diagnosis, tumour location, surgical interventions, cranial irradiation and systemic or intrathecal chemotherapy. Such changes can disrupt neural connectivity, leading to difficulties with learning, academic achievement and psychosocial adaptation. Risk stratification is now a priority, seeking to identify those most vulnerable to adverse outcomes and to tailor follow-up care accordingly. Intervention programmes ranging from cognitive remediation and educational support to physical exercise and pharmacotherapy are under evaluation, aiming to mitigate impairment and enhance quality of life. The global significance of this issue is underscored by its impact on long-term social integration, employment prospects and mental health of childhood cancer survivors.

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Neurocognitive Outcomes in Pediatric Cancer Survivorship publication trend

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Technical terms

White matter integrity: A measure of the structural organisation and coherence of myelinated nerve fibres that facilitate efficient neural signalling.

Grey matter volume: The total mass of neuronal cell bodies, dendrites and unmyelinated axons in a given brain region, reflecting local processing capacity.

Diffusion tensor imaging (DTI): An MRI technique that quantifies the directional movement of water molecules to assess microstructural properties of white matter.

Voxel-based morphometry (VBM): A neuroimaging analysis method that detects regional differences in brain tissue volume by comparing voxel-wise measures across individuals.

Leukoencephalopathy: A pathological condition characterised by damage to the white matter, often leading to cognitive and motor deficits.

References

1. Impact of Chemotherapy for Childhood Leukemia on Brain Morphology and Function. PLOS ONE (2013).
2. Disruption of White Matter Integrity in Adult Survivors of Childhood Brain Tumors: Correlates with Long-Term Intellectual Outcomes. PLOS ONE (2015).
3. Chemotherapy and the pediatric brain. Molecular and Cellular Pediatrics (2018).