Medulloblastoma medical therapy: Difference between revisions

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Latest revision as of 02:34, 27 November 2017

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

Risk stratification

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:

Altered cognitive level
Deafness
Endocrinopathies^[3]

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

↑ ^1.0 ^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.
↑ ^2.0 ^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
↑ ^3.0 ^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.
↑ Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 28 2015)

Template:WikiDoc Sources

[pmid22622599-1] 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.

[N-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

[pmid23245832-3] 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.

[b-4] Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 28 2015)

[1]

[2]

[3]

[4]

@@ Line 4: / Line 4: @@
 ==Overview==
-The risk stratification criteria predicts the protocol used for the management of 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.<ref name="pmid22622599">{{cite journal| author=von Hoff K, Rutkowski S| title=Medulloblastoma. | journal=Curr Treat Options Neurol | year= 2012 | volume= 14 | issue= 4 | pages= 416-26 | pmid=22622599 | doi=10.1007/s11940-012-0183-8 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22622599  }} </ref><ref name="N"> 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</ref>
+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]].<ref name="pmid22622599">{{cite journal| author=von Hoff K, Rutkowski S| title=Medulloblastoma. | journal=Curr Treat Options Neurol | year= 2012 | volume= 14 | issue= 4 | pages= 416-26 | pmid=22622599 | doi=10.1007/s11940-012-0183-8 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22622599  }} </ref><ref name="N"> 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</ref>
-__NOTOC__
 ==Medical Therapy==
-* The algorithm below summarize the management approach for medulloblastoma patients:<ref name="pmid22622599">{{cite journal| author=von Hoff K, Rutkowski S| title=Medulloblastoma. | journal=Curr Treat Options Neurol | year= 2012 | volume= 14 | issue= 4 | pages= 416-26 | pmid=22622599 | doi=10.1007/s11940-012-0183-8 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22622599  }} </ref><ref name="N"> 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</ref>
+* The algorithm below summarizes the management approach for medulloblastoma patients:<ref name="pmid22622599">{{cite journal| author=von Hoff K, Rutkowski S| title=Medulloblastoma. | journal=Curr Treat Options Neurol | year= 2012 | volume= 14 | issue= 4 | pages= 416-26 | pmid=22622599 | doi=10.1007/s11940-012-0183-8 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22622599  }} </ref><ref name="N"> 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</ref>
 <br>
 {{Family tree/start}}
-{{Family tree | | | | A01 | | | |A01=<div style="width: 20em; padding:1em;">'''Optimal surgical excision'''</div>}}
+{{Family tree | | | | A01 | | | |A01=<div style="width: 15em; padding:1em;">'''Optimal surgical excision'''</div>}}
 {{Family tree | | | | |!| | | | | }}
-{{Family tree | | | | B01 | | | |B01=<div style="width: 20em; padding:)0.5em;">'''Histopathological analysis and detailed staging'''</div>}}
+{{Family tree | | | | B01 | | | |B01=<div style="width: 15em; padding:)0.5em;">'''Histopathological analysis and detailed staging'''</div>}}
 {{Family tree | | | | |!| | | | | }}
-{{Family tree | | | | B01 | | | |B01=<div style="width: 20em; padding:0.5;">'''[[#Risk Stratification Criteria|Risk stratification]]'''</div>}}
+{{Family tree | | | | B01 | | | |B01=<div style="width: 15em; padding:0.5;">'''[[#Risk Stratification|Risk stratification]]'''</div>}}
 {{Family tree | | | | |!| | | | | }}
 {{familytree  | | | | Y01 | | | | | | | | | | Y01=<div style="width: 20em; padding:0.5em;">'''Radiotherapy and chemotherapy'''
@@ Line 23: / Line 21: @@
 {{familytree  | | X01 | |  X02 | | | | | | |X01='''Standard risk patients'''| X02='''High risk patients'''}}
 {{familytree|boxstyle= border-top: 0px;| | A01 | |  A03 | | | | | | |A01=<div style="width: 20em; padding:1em;">
-'''Craniospinal radiation <u>OR</u> Concurrent chemoradiotherapy followed by [[#Chemotherapy|chemotherapeutic regimens]]'''</div>|A03=<div style="width: 20em; padding:1em;">|A03=<div style="width: 20em; padding:1em;">
+'''Craniospinal radiation <br>{{or}}<br> Chemoradiotherapy followed by additional [[#Chemotherapy|chemotherapy]]'''</div>|A03=<div style="width: 15em; padding:1em;">|A03=<div style="width: 15em; padding:1em;">
-'''Craniospinal radiation followed by chemotherapeutic regimens'''</div>}}
+'''[[#Radiation Therapy|Craniospinal radiation]] followed by chemotherapy'''</div>}}
 {{Family tree/end}}
-<br>
-===Risk Stratification Criteria===
+===Risk Stratification===
-* The risk stratification criteria predicts the protocol used for the management of medulloblastoma patients.<ref name="pmid23245832">{{cite journal| author=Bartlett F, Kortmann R, Saran F| title=Medulloblastoma. | journal=Clin Oncol (R Coll Radiol) | year= 2013 | volume= 25 | issue= 1 | pages= 36-45 | pmid=23245832 | doi=10.1016/j.clon.2012.09.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23245832  }} </ref><ref name="b">Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 28th 2015)</ref>
+* Risk stratification determines the protocol of management used for medulloblastoma patients.<ref name="pmid23245832">{{cite journal| author=Bartlett F, Kortmann R, Saran F| title=Medulloblastoma. | journal=Clin Oncol (R Coll Radiol) | year= 2013 | volume= 25 | issue= 1 | pages= 36-45 | pmid=23245832 | doi=10.1016/j.clon.2012.09.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23245832  }} </ref><ref name="b">Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 28 2015)</ref>
-* The table below demonstrates the risk stratification criteria for medulloblastoma patients:
+* The table below demonstrates the risk stratification for medulloblastoma patients:
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
@@ Line 61: / Line 58: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |
 :::M1-M3 stage '''or''' presence of [[leptomeningeal]] seeding
+|-
+| style="background: #CEDCED; width: 150px; padding:7px;" | '''Management Protocol'''
+| style="background: #CEDCED; width: 400px; text-align:center; padding:7px;" |Craniospinal radiation  <br>{{or}}<br>  Chemoradiotherapy followed by additional chemotherapy
+| style="background: #CEDCED; width: 450px; text-align:center; padding:7px;" |Craniospinal radiation followed by chemotherapy
 |}
 ===Radiation Therapy===
-* Radiotherapy is the mainstay of treatment for medulloblastoma.<ref name="pmid23245832">{{cite journal| author=Bartlett F, Kortmann R, Saran F| title=Medulloblastoma. | journal=Clin Oncol (R Coll Radiol) | year= 2013 | volume= 25 | issue= 1 | pages= 36-45 | pmid=23245832 | doi=10.1016/j.clon.2012.09.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23245832  }} </ref>
+* Radiotherapy is the mainstay of treatment for medulloblastoma.
-* Radiotherapy for medulloblastoma must be started within the 6 weeks period following surgery.
+* [[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
@@ Line 71: / Line 72: @@
 :* Three dimensional radiotherapy technique
 * Three dimensional radiotherapy technique demonstrated better outcomes when compared to conventional and intensity modulated radiotherapy techniques.
-* The radiotherapy dose is adjusted according to the risk stratification of medulloblastoma patients.
+* 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.
+* 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:
-:* Altered cognitive level
+:* Altered [[cognitive]] level
-:* Deafness
+:* [[Deafness]]
-:* Endocrinopathies
+:* Endocrinopathies<ref name="pmid23245832">{{cite journal| author=Bartlett F, Kortmann R, Saran F| title=Medulloblastoma. | journal=Clin Oncol (R Coll Radiol) | year= 2013 | volume= 25 | issue= 1 | pages= 36-45 | pmid=23245832 | doi=10.1016/j.clon.2012.09.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23245832  }} </ref>
 ===Chemotherapy===
-* Adjunctive chemotherapy is required for the management of medulloblastoma patients.<ref name="pmid22622599">{{cite journal| author=von Hoff K, Rutkowski S| title=Medulloblastoma. | journal=Curr Treat Options Neurol | year= 2012 | volume= 14 | issue= 4 | pages= 416-26 | pmid=22622599 | doi=10.1007/s11940-012-0183-8 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22622599  }} </ref><ref name="N"> 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</ref>
+* 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]]
+* 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:
-* Recommended chemotherapeutic regimens used for the management of high risk medulloblastoma patients include is [[cyclophosphamide]] {{and}} [[vincristine]] {{and}}  [[cisplatin]]
+:* [[Cyclophosphamide]]
-* Other chemotheuraptic agents used for the management of medulloblastoma iclude:
 :* [[Carboplatin]]
 :* [[Etoposide]]
-:* [[Temozolomide]]
+:* [[Temozolomide]]<ref name="pmid22622599">{{cite journal| author=von Hoff K, Rutkowski S| title=Medulloblastoma. | journal=Curr Treat Options Neurol | year= 2012 | volume= 14 | issue= 4 | pages= 416-26 | pmid=22622599 | doi=10.1007/s11940-012-0183-8 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22622599  }} </ref><ref name="N"> 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</ref>
 ==References==
@@ Line 98: / Line 98: @@
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+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Neurology]]
+[[Category:Neurosurgery]]