Lessons in pediatric neuropsycho-oncology: what we have learned since Johnny Gunther.

OBJECTIVE This article provides a commentary on the progression of research over the last six decades into the neurobehavioral outcomes of children treated for intracranial tumors. METHODS Published studies and literature reviews are surveyed, with illustrations from the author's ongoing longitudinal study. RESULTS Research on late effects in pediatric brain tumors continues to increase in both volume and quality. Samples are larger and more differentiated, scope of outcome measurement has increased, and more powerful developmental research designs are being used. Particularly promising recent developments are described, including research on: imaging-behavior relationships, improved modeling of dose-volume heterogeneity in radiation therapy, improved late effects measurement, and treatments for neurobehavioral sequelae. CONCLUSIONS There is now a large body of scientific evidence of increasing sophistication regarding the outcomes of patients receiving the most toxic treatments. It is argued that more research into the neuropsychological effects associated with "benign" tumors of childhood is needed.