The rationale for early detection and treatment of brain tumors in survivors of childhood cancer

Survivors of childhood cancer have a relatively high risk of developing second cancers. The incidence of brain tumor in these patients approaches 1% at 10 years, over 80-fold that in the general population. This high incidence increases the likelihood that early detection of brain tumors in survivors of childhood cancer is feasible. By analogy with other epithelial cancers, detection and treatment of brain tumors at a pre-neoplastic or premalignant stage may render screening and treatment cost effective for certain high-risk populations. Our animal studies with a clinically appropriate model of this condition suggest that there is a pre-neoplastic, pre-malignant brain tumor lesion that is potentially both detectable and effectively treated. The possibility of detecting such a treatable antecedent to brain tumors provides the rationale for genomic and proteomic screening of tumor tissue, CSF, plasma and urine in this animal model, of tumor tissue and body fluids of patients with known brain tumors at various stages, and of body fluids of survivors of childhood cancer.