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

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)

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