Return to sports after pediatric brain tumors: time to move beyond survival

Abstract

Brain tumors are the second most common malignancy in children and adolescents and the leading cause of cancer-related death in this population. While survival rates have improved, survivors are at risk of neurocognitive, motor, and psychosocial sequelae due to both tumor location and treatments used. Participation in sport is increasingly recognized as beneficial for functional recovery, cardiorespiratory fitness, and overall well-being in children and adolescents treated for brain tumors. However, return to play (RTP) may pose some challenges, particularly in the presence of neurosurgical devices, cranial radiotherapy, or residual neurological deficits.

This narrative clinical review summarizes current evidence on the risks of sport-related injuries in pediatric brain tumor patients and survivors, highlighting factors influencing vulnerability, including treatment history and specific sport characteristics.

We propose a risk-based framework for RTP evaluation emphasizing individualized coordinated assessment by pediatric oncologists, neurosurgeons, and sports medicine specialists. Protective strategies are discussed, although evidence for concussion prevention remains limited. A safe RTP should be enhanced by the here-proposed structured evaluation, balancing safety with the physical, cognitive, and psychosocial benefits of active participation.

This framework aims to support clinicians and families in facilitating safe and effective reintegration of pediatric brain tumor survivors into both recreational and competitive sports.