Medulloblastoma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]

Overview

Risk stratification determines the protocol of management used for medulloblastoma patients. Radiotherapy is the mainstay of treatment for medulloblastoma. Radiotherapy for medulloblastoma must be started within the 6 weeks period following surgery. Adjunctive chemotherapy is also required for the management of certain medulloblastoma patients. Recommended chemotherapeutic regimens used for the management of standard risk medulloblastoma patients include a combination of lomustine, vincristine, and cisplatin.[1][2]

Medical Therapy

  • The algorithm below summarizes the management approach for medulloblastoma patients:[1][2]


 
 
 
Optimal surgical excision
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Histopathological analysis and detailed staging
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Radiotherapy and chemotherapy administered according to the risk stratification criteria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Standard risk patients
 
High risk patients
 
 
 
 
 
 
 
Craniospinal radiation
OR
Chemoradiotherapy followed by additional chemotherapy
 
Craniospinal radiation followed by chemotherapy
 
 
 
 
 
 


Risk Stratification

  • Risk stratification determines the protocol of management used for medulloblastoma patients.[3][4]
  • The table below demonstrates the risk stratification for medulloblastoma patients:
Parameters Standard Risk Group High Risk Group

Age

Patients older than 3 years of age
Patients younger than 3 years of age

Extent of previous surgical resection

<1.5 cm² residual tumor after resection
Subtotal resection or >1.5 cm² residual tumor after resection

Tumor stage

M0 stage confirmed by MRI and CSF sampling
M1-M3 stage or presence of leptomeningeal seeding
Management Protocol Craniospinal radiation
OR
Chemoradiotherapy followed by additional chemotherapy
Craniospinal radiation followed by chemotherapy

Radiation Therapy

  • Radiotherapy is the mainstay of treatment for medulloblastoma.
  • Radiotherapy for medulloblastoma must be started within the 6 weeks period following surgery.
  • The main radiotherapy techniques used in the management of medulloblastoma patients include:
  • Conventional radiotherapy technique
  • Intensity modulated radiotherapy technique
  • Three dimensional radiotherapy technique
  • Three dimensional radiotherapy technique demonstrated better outcomes when compared to conventional and intensity modulated radiotherapy techniques.
  • The dose of radiation is adjusted according to the risk stratification of medulloblastoma patients.
  • As medulloblastoma tends to spread along the cerebrospinal fluid, it is recommended to deliver a craniospinal irradiation with a boost to the posterior fossa.
  • Side effects of radiotherapy may include:

Chemotherapy

  • Adjunctive chemotherapy is required for the management of medulloblastoma patients.
  • Recommended chemotherapeutic regimens used for the management of standard risk medulloblastoma patients include a combination of lomustine AND vincristine AND cisplatin
  • Other chemotheuraptic agents that may be used for the management of high risk medulloblastoma patients include:

References

  1. 1.0 1.1 1.2 von Hoff K, Rutkowski S (2012). "Medulloblastoma". Curr Treat Options Neurol. 14 (4): 416–26. doi:10.1007/s11940-012-0183-8. PMID 22622599.
  2. 2.0 2.1 2.2 Clinical Practice Guidelines in Oncology Central Nervous System Cancers. National Comprehensive Cancer Network.(2015) http://www.lecba-rakoviny.cz/dokumenty/NCCN_Guidelines_cns_2011.pdf Accessed on September,25 2015
  3. 3.0 3.1 Bartlett F, Kortmann R, Saran F (2013). "Medulloblastoma". Clin Oncol (R Coll Radiol). 25 (1): 36–45. doi:10.1016/j.clon.2012.09.008. PMID 23245832.
  4. Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 28 2015)

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