Medulloblastoma medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(Mahshid)
 
(41 intermediate revisions by 3 users not shown)
Line 4: Line 4:


==Overview==
==Overview==
__NOTOC__
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>
 
==Medical Therapy==
==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> 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>
<br>
{{Family tree/start}}
{{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 | | | | |!| | | | | }}
{{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 | | | | |!| | | | | }}
{{Family tree | | | | B01 | | | |B01=<div style="width: 20em; padding:0.5;">'''Risk stratification'''</div>}}
{{Family tree | | | | B01 | | | |B01=<div style="width: 15em; padding:0.5;">'''[[#Risk Stratification|Risk stratification]]'''</div>}}
{{Family tree | | | | |!| | | | | }}
{{Family tree | | | | |!| | | | | }}
{{familytree  | | | | Y01 | | | | | | | | | | Y01=<div style="width: 20em; padding:0.5em;">'''Radiotherapy and chemotherapy'''
{{familytree  | | | | Y01 | | | | | | | | | | Y01=<div style="width: 20em; padding:0.5em;">'''Radiotherapy and chemotherapy'''
'''administered according to the risk stratification criteria'''</div>}}
'''administered according to the risk stratification criteria'''</div>}}
{{familytree  | | |,|-|^|-|.| | | | | | | | }}
{{familytree  | | |,|-|^|-|.| | | | | | | | }}
{{familytree  | | A01 | |  A03 | | | | | | |A01=<div style="width: 20em; padding:1em;">'''Standard risk patients'''<br>
{{familytree  | | X01 | |  X02 | | | | | | |X01='''Standard risk patients'''| X02='''High risk patients'''}}
'''Craniospinal radiation <u>OR</u> Concurrent chemoradiotherapy followed by chemotherapeutic regimens'''</div>|A03=<div style="width: 20em; padding:1em;">|A03=<div style="width: 20em; padding:1em;">'''High risk patients'''<br>
{{familytree|boxstyle= border-top: 0px;| | A01 | |  A03 | | | | | | |A01=<div style="width: 20em; padding:1em;">
'''Craniospinal radiation followed by chemotherapeutic regimens'''</div>}}
'''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;">
'''[[#Radiation Therapy|Craniospinal radiation]] followed by chemotherapy'''</div>}}
{{Family tree/end}}
{{Family tree/end}}
<br>




===Risk Stratification Criteria===
===Risk Stratification===
* The risk stratification criteria may help predict the protocol that should be used for the treatment 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"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
Line 57: Line 58:
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
:::M1-M3 stage '''or''' presence of [[leptomeningeal]] seeding
:::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===
===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 6 weeks 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:
* The main radiotherapy techniques used in the management of medulloblastoma patients include:
:* Conventional radiotherapy technique
:* Conventional radiotherapy technique
Line 67: Line 72:
:* Three dimensional radiotherapy technique
:* Three dimensional radiotherapy technique
* Three dimensional radiotherapy technique demonstrated better outcomes when compared to conventional and intensity modulated radiotherapy techniques.
* 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:
* 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===
===Chemotherapy===
* Adjunctive chemotherapy are 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="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="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.
* The recommended chemotherapeutic regimen used for the management of standard risk medulloblastoma patients is 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:
* The recommended chemotherapeutic regimen used for the management of high risk medulloblastoma patients is [[cyclophosphamide]] and [[vincristine]] and cisplatin
:* [[Cyclophosphamide]]
* Other chemotherapeutic agents used in the management of medulloblastoma patients include:
:* [[Carboplatin]]
:* [[Carboplatin]]
:* [[Etoposide]]
:* [[Etoposide]]
:* [[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>
:* [[Temozolomide]]


==References==
==References==
Line 94: Line 98:
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Neurology]]
[[Category:Neurosurgery]]

Latest revision as of 02:34, 27 November 2017

Medulloblastoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Medulloblastoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Staging

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case studies

Case #1

Medulloblastoma medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Medulloblastoma medical therapy

All Images
X-rays
Echo and Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Medulloblastoma medical therapy

CDC on Medulloblastoma medical therapy

Medulloblastoma medical therapy in the news

Blogs on Medulloblastoma medical therapy

Directions to Hospitals Treating Medulloblastoma

Risk calculators and risk factors for Medulloblastoma medical therapy

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)


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Medulloblastoma_medical_therapy&oldid=1395020"