Potential of Photodynamic Therapy in Children and Adolescents with Central Nervous System Tumors

Central nervous system (CNS) tumors in children, though uncommon, pose distinct challenges due to their unique pathological and clinical features, which often differ from adult cases. Effective management of pediatric CNS tumors can be complicated, with complete surgical resection remaining a critical goal, in conditions like cerebra cavernous malformation (CCM), where it significantly impacts recurrence risk. However, achieving complete resection can be difficult, as preserving the surrounding healthy tissue is vital to avoid long-term neurological deficits, a particular concern in the developing brains of children. Photodynamic therapy (PDT) has emerged as a promising adjunctive treatment for pediatric CNS tumors due to its ability to selectively target tumor cells while sparing healthy tissue. PDT uses a photosensitizing agent. This targeted approach is advantageous in pediatric cases as it minimizes collateral damage, potentially reducing the long-term neurological and cognitive impacts seen with conventional treatments such as radiation. Despite its promise, the application of PDT for pediatric CNS tumors remains underexplored. Research is limited, primarily due to the rarity of these tumors in children and the ethical challenges involved in conducting pediatric trials. The current understanding of PDT’s effectiveness in CNS tumors largely stems from adult studies, which may not fully apply to children’s unique developmental and physiological characteristics, including differences in the tumor biology, metabolism, and pharmacokinetics of photosensitizers. To address this gap, our study conducted a comprehensive review of the available literature using PubMed, Google Scholar, and additional databases like Web of Science, aiming to summarize the existing knowledge on PDT for pediatric CNS tumors, incorporate recent advancements from the last years, and identify areas where further research is essential. The updated review includes new insights from ongoing sonodynamic therapy (SDT), which complements PDT by using ultrasound to enable deeper penetration.