Medulloblastoma medical therapy: Difference between revisions

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===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 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:
:* [[Lomustine]]
:* [[Vincristine]]
:* [[Cisplatin]]
* Chemotherapeutic agents used for management of high risk medulloblastoma patients include:
:* [[Carboplatin]]
:* [[Cyclophosphamide]]
:* [[Vincristine]]
:* [[Cisplatin]]


===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><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 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
|}
|}
===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 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:
:* [[Lomustine]]
:* [[Vincristine]]
:* [[Cisplatin]]
* Chemotherapeutic agents used for management of high risk medulloblastoma patients include:
:* [[Carboplatin]]
:* [[Cyclophosphamide]]
:* [[Vincristine]]
:* [[Cisplatin]]


==References==
==References==

Revision as of 18:16, 2 October 2015

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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

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
 
 
 
 
 
 



Risk Stratification Criteria

  • The risk stratification criteria may help predict the protocol that should be used for the treatment of medulloblastoma patients.[2][3][4]
  • The table below demonstrates the risk stratification criteria 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

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:


References

  1. ↑ 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 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.
  3. ↑ Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 28th 2015)
  4. ↑ 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


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