Medulloblastoma medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
__NOTOC__ | |||
==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> | * 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> | ||
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{{Family tree | | | | A01 | | | |A01=<div style="width: 20em; padding:1em;">'''Optimal surgical excision'''</div>}} | {{Family tree | | | | A01 | | | |A01=<div style="width: 20em; padding:1em;">'''Optimal surgical excision'''</div>}} | ||
{{Family tree | | | | |!| | | | | }} | {{Family tree | | | | |!| | | | | }} | ||
{{Family tree | | | | B01 | | | |B01=<div style="width: 20em; padding:1em;">'''Histopathological analysis | {{Family tree | | | | B01 | | | |B01=<div style="width: 20em; padding:1em;">'''Histopathological analysis and detailed staging'''</div>}} | ||
{{Family tree | | | | |!| | | | | }} | {{Family tree | | | | |!| | | | | }} | ||
{{Family tree | | | | B01 | | | |B01=<div style="width: 20em; padding:1em;">'''Risk stratification'''</div>}} | {{Family tree | | | | B01 | | | |B01=<div style="width: 20em; padding:1em;">'''Risk stratification'''</div>}} | ||
{{Family tree | | | | |!| | | | | }} | {{Family tree | | | | |!| | | | | }} | ||
{{ | {{familytree | | | | Y01 | | | | | | | | | | Y01=<div style="width: 20em; padding:1em;">'''Radiotherapy and chemotherapy''' | ||
'''administered according to the risk stratification criteria'''</div>}} | '''administered according to the risk stratification criteria'''</div>}} | ||
{{familytree |,|-|-|-|^|-|-|-|.| | | | | | }} | |||
{{familytree |A01 | | | | | | A03 | | | | |A01=<div style="width: 20em; padding:1em;">'''Standard risk patients'''<br> | |||
'''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> | |||
'''Craniospinal radiation followed by chemotherapeutic regimens'''</div>}} | |||
{{Family tree/end}} | {{Family tree/end}} | ||
<br> | <br> | ||
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:* 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. | |||
* 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 | |||
:* Deafness | |||
:* Endocrinopathies | |||
===Chemotherapy=== | ===Chemotherapy=== | ||
* Adjunctive chemotherapy are required for the management of medulloblastoma patients. | |||
* Chemotherapeutic agents used for management of standard risk medulloblastoma patients include: | |||
:* [[Lomustine]] | |||
:* [[Vincristine]] | |||
:* [[Cisplatin]] | |||
* Chemotherapeutic agents used for management of high risk medulloblastoma patients include: | |||
:* [[Carboplatin]] | |||
:* [[Cyclophosphamide]] | |||
:* [[Vincristine]] | |||
:* [[Cisplatin]] | |||
* The optimal chemotherapeutic regimen for standard risk patients is 8 cycles of lomustine '''<u>AND</u>''' vincristine '''<u>AND</u>''' | |||
===Risk Stratification Criteria=== | ===Risk Stratification Criteria=== | ||
* 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> | * 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> | ||
* The table below demonstrates the risk stratification criteria for medulloblastoma patients: | * The table below demonstrates the risk stratification criteria for medulloblastoma patients: | ||
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:::M1-M3 stage '''or''' presence of [[leptomeningeal]] seeding | :::M1-M3 stage '''or''' presence of [[leptomeningeal]] seeding | ||
|} | |} | ||
==References== | ==References== | ||
Revision as of 14:19, 2 October 2015
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Medulloblastoma Microchapters |
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Diagnosis |
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Treatment |
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Case studies |
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Medulloblastoma medical therapy On the Web |
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American Roentgen Ray Society Images of Medulloblastoma medical therapy |
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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
Medical Therapy
- The algorithm below summarize the management approach for medulloblastoma patients:[1]
Optimal surgical excision | |||||||||||||||||||||||||||||
Histopathological analysis and detailed staging | |||||||||||||||||||||||||||||
Risk stratification | |||||||||||||||||||||||||||||
Radiotherapy and chemotherapy
administered according to the risk stratification criteria | |||||||||||||||||||||||||||||
Standard risk patients Craniospinal radiation OR Concurrent chemoradiotherapy followed by chemotherapeutic regimens | High risk patients Craniospinal radiation followed by chemotherapeutic regimens | ||||||||||||||||||||||||||||
Radiation Therapy
- Radiotherapy is the mainstay of treatment for medulloblastoma.[2]
- Radiotherapy for medulloblastoma must be started within 6 weeks 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 radiotherapy dose 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
Chemotherapy
- Adjunctive chemotherapy are required for the management of medulloblastoma patients.
- Chemotherapeutic agents used for management of standard risk medulloblastoma patients include:
- Chemotherapeutic agents used for management of high risk medulloblastoma patients include:
- The optimal chemotherapeutic regimen for standard risk patients is 8 cycles of lomustine AND vincristine AND
Risk Stratification Criteria
- The risk stratification criteria may help predict the protocol that should be used for the treatment of medulloblastoma patients.[2][3]
- The table below demonstrates the risk stratification criteria for medulloblastoma patients:
| Parameters | Standard Risk Group | High Risk Group |
|---|---|---|
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Age |
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Extent of previous surgical resection |
|
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Tumor stage |
|
References
- ↑ 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 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, 28th 2015)