The overall 5‐year survival probability for children with central nervous system (CNS) tumors is approximately 67%. Pediatric patients generally have a better prognosis than adults with CNS tumors, although the morbidity from these tumors and their treatment can be very substantial. As more children with CNS tumors survive and require treatment in primary care settings, it is increasingly important for health care providers to anticipate and recognize long‐term medical and neurocognitive complications. The purpose of this article is to provide a concise review of the long‐term effects of pediatric CNS tumors and their treatment.

Alcohol consumption has substantially increased during the COVID-19 pandemic 1 ; however, the impact on the already increasing burden of alcohol-associated liver disease (ALD) is unknown. 2 We examined national changes in waiting list registration and liver transplantation for ALD and the association with alcohol sales during the COVID-19 pandemic. We hypothesized that waiting list registrations and deceased donor liver transplants (DDLTs) for alcoholic hepatitis (AH), which can develop after a short period of alcohol misuse, would disproportionately rise. MethodsThis cross-sectional study was deemed exempt from review and informed consent by the University of Michigan institutional review board because the study involves deidentified, publicly available secondary data sets that cannot be tracked back to an individual. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for reporting cross-sectional studies. Data were obtained from the United Network for Organ Sharing Standard Transplant Analysis and Research file for new waiting list registrations and primary DDLT for US adults (age Ն18 years) between January 1, 2016, and January 31, 2021, and categorized by primary listing diagnosis as AH, alcohol-related cirrhosis (AC), or non-ALD (any other diagnosis). For each diagnosis, we characterized short-term changes during COVID-19 (March 2020 to January 2021) by comparing proportions of waiting list registrations and DDLTs to the same time frame pre-COVID-19 (March 2019 to January 2020) using χ 2 tests. To evaluate changes during COVID-19 compared with long-term trends, we compared observed monthly volumes of waiting list registrations and DDLTs from March 2020 to January 2021 with forecasted values based on pre-COVID-19 trends estimated from nonseasonal autoregressive integrated moving average models with first order differencing fit to monthly waiting list registrations and DDLTs for 4 years pre-COVID-19 (January 2016 to February 2020). 3 National monthly retail alcohol sales from January 2016 to January 2021 for purchases from beer, wine, and liquor stores in US dollars were obtained from the US Census Bureau Monthly Retail Trade Report. 4 The associations of alcohol sales, waiting list registrations, and DDLT were evaluated using Spearman rank-order correlation with a significance level of .05. Analyses were performed using Stata/SE version 16.0 (StataCorp). Data were analyzed from March to April 2021.

Maria was born in the Dominican Republic. She married a United States citizen, immigrated to this country, and obtained "conditional" resident immigration status, which enabled her to remain legally in the United States provided that she stay wedded to her spouse. Soon afterward, her husband began to brutalize her physically. "One time I had eight stitches in my head and a gash on the other side of my head, and he broke my ribs.... He would bash my head against the wall while we had sex. He kept threatening to kill me if I told the doctor what happened."' Afraid of the risk of deportation, Maria endured her husband's treatment for months. After she finally fled, her spouse demanded that she return to his apartment for her immigration documents. At first, she told him, "No, you're going to hit me." But then she realized that she had to go because she needed the papers. She described the consequences: "He beat me on the head. He sat on my stomach. He put a knife to my throat and raped me. Then he threw me naked on the street." 2

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With improved survivorship in medulloblastoma, there has been an increasing incidence of late complications. To date, no studies have specifically addressed the risk of radiation-associated diffuse intrinsic pontine glioma (DIPG) in medulloblastoma survivors. Query of the International DIPG Registry identified six cases of DIPG with a history of medulloblastoma treated with radiotherapy. All patients underwent central radiologic review that confirmed a diagnosis of DIPG. Six additional cases were identified in reports from recent cooperative group medulloblastoma trials (total n = 12; ages 7 to 21 years). From these cases, molecular subgrouping of primary medulloblastomas with available tissue (n = 5) revealed only non-WNT, non-SHH subgroups (group 3 or 4). The estimated cumulative incidence of DIPG after post-treatment medulloblastoma ranged from 0.3–3.9%. Posterior fossa radiation exposure (including brainstem) was greater than 53.0 Gy in all cases with available details. Tumor/germline exome sequencing of three radiation-associated DIPGs revealed an H3 wild-type status and mutational signature distinct from primary DIPG with evidence of radiation-induced DNA damage. Mutations identified in the radiation-associated DIPGs had significant molecular overlap with recurrent drivers of adult glioblastoma (e.g. NRAS, EGFR, and PTEN), as opposed to epigenetic dysregulation in H3-driven primary DIPGs. Patients with radiation-associated DIPG had a significantly worse median overall survival (median 8 months; range 4–17 months) compared to patients with primary DIPG. Here, it is demonstrated that DIPG occurs as a not infrequent complication of radiation therapy in survivors of pediatric medulloblastoma and that radiation-associated DIPGs may present as a poorly-prognostic distinct molecular subgroup of H3 wild-type DIPG. Given the abysmal survival of these cases, these findings provide a compelling argument for efforts to reduce exposure of the brainstem in the treatment of medulloblastoma. Additionally, patients with radiation-associated DIPG may benefit from future therapies targeted to the molecular features of adult glioblastoma rather than primary DIPG.Electronic supplementary materialThe online version of this article (10.1186/s40478-018-0570-9) contains supplementary material, which is available to authorized users.