Overcoming emerging challenges in childhood cancer survivorship: a spotlight on pediatric CNS tumors

INTRODUCTION: Pediatric central nervous system (CNS) tumors are the most common solid malignancies in children. Advances in multimodal therapies have improved survival, resulting in a growing population of long-term survivors who often experience treatment-related morbidity affecting quality of life and functional outcomes. This underscores the importance of comprehensive survivorship care. AREAS COVERED: This review summarizes the multisystem late effects of pediatric CNS tumor treatment, including endocrine dysfunction, fertility impairment, neurocognitive and psychosocial sequelae, second malignant neoplasms, cardiovascular complications, bone health deficits, ototoxicity, and renal, pulmonary, gastrointestinal, and dermatologic toxicities. Emerging survivorship challenges associated with immunotherapy and targeted therapies are also discussed. We further review evidence-based surveillance strategies, interventions to mitigate long-term complications, and current recommendations for risk-adapted follow-up and transition to adult care. EXPERT OPINION: Survivors of pediatric CNS tumors represent one of the highest-risk groups among childhood cancer survivors because of the cumulative burden of endocrine, neurocognitive, cardiometabolic, and psychosocial late effects. Future survivorship care should adopt personalized, multidisciplinary, and risk-stratified approaches, integrating dedicated survivorship clinics, structured transition programs, and long-term monitoring. Improving quality of survival should be prioritized alongside continued gains in survival outcomes.