Alessi Iside, Caroleo Anna Maria, de Palma Luca, Mastronuzzi Angela, Pro Stefano, Colafati Giovanna Stefania, Boni Alessandra, Della Vecchia Nicoletta, Velardi Margherita, Evangelisti Melania, Carboni Alessia, Carai Andrea, Vinti Luciana, Valeriani Massimiliano, Reale Antonino, Parisi Pasquale, Raucci Umberto
Department of Hematology/Oncology, Gene Therapy and Hematopoietic Transplantation, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Child Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Cancers (Basel). 2022 Mar 17;14(6):1540. doi: 10.3390/cancers14061540.
Neurotoxicity caused by traditional chemotherapy and radiotherapy is well known and widely described. New therapies, such as biologic therapy and immunotherapy, are associated with better outcomes in pediatric patients but are also associated with central and peripheral nervous system side effects. Nevertheless, central nervous system (CNS) toxicity is a significant source of morbidity in the treatment of cancer patients. Some CNS complications appear during treatment while others present months or even years later. Radiation, traditional cytotoxic chemotherapy, and novel biologic and targeted therapies have all been recognized to cause CNS side effects; additionally, the risks of neurotoxicity can increase with combination therapy. Symptoms and complications can be varied such as edema, seizures, fatigue, psychiatric disorders, and venous thromboembolism, all of which can seriously influence the quality of life. Neurologic complications were seen in 33% of children with non-CNS solid malign tumors. The effects on the CNS are disabling and often permanent with limited treatments, thus it is important that clinicians recognize the effects of cancer therapy on the CNS. Knowledge of these conditions can help the practitioner be more vigilant for signs and symptoms of potential neurological complications during the management of pediatric cancers. As early detection and more effective anticancer therapies extend the survival of cancer patients, treatment-related CNS toxicity becomes increasingly vital. This review highlights major neurotoxicities due to pediatric cancer treatments and new therapeutic strategies; CNS primary tumors, the most frequent solid tumors in childhood, are excluded because of their intrinsic neurological morbidity.
传统化疗和放疗引起的神经毒性已广为人知且有大量描述。新的疗法，如生物疗法和免疫疗法，在儿科患者中能带来更好的治疗效果，但也与中枢和外周神经系统副作用相关。然而，中枢神经系统（CNS）毒性仍是癌症患者治疗中发病的一个重要原因。一些中枢神经系统并发症在治疗期间出现，而另一些则在数月甚至数年之后才显现。放疗、传统细胞毒性化疗以及新型生物疗法和靶向疗法都已被确认会导致中枢神经系统副作用；此外，联合治疗会增加神经毒性风险。症状和并发症多种多样，如水肿、癫痫、疲劳、精神障碍和静脉血栓栓塞，所有这些都会严重影响生活质量。在患有非中枢神经系统实体恶性肿瘤的儿童中，33%出现了神经系统并发症。对中枢神经系统的影响具有致残性，而且在治疗手段有限的情况下往往是永久性的，因此临床医生认识到癌症治疗对中枢神经系统的影响非常重要。了解这些情况有助于从业者在治疗儿童癌症时，对潜在神经并发症的体征和症状更加警惕。随着早期检测和更有效的抗癌疗法延长了癌症患者的生存期，与治疗相关的中枢神经系统毒性变得越发重要。本综述重点介绍了儿科癌症治疗导致的主要神经毒性以及新的治疗策略；中枢神经系统原发性肿瘤是儿童最常见的实体肿瘤，因其本身具有神经方面的发病率而被排除在外。
