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]

Medical Therapy

• The algorithm below summarize the management approach for medulloblastoma patients:

Optimal surgical excision

Histopathological analysis

Detailed staging

Risk stratification

Radiotherapy and chemotherapy administered according to the 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.
• 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.
• 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.
• As medulloblastoma tends to spread along the cerebrospinal fluid, it is recommended to deliver a craniospinal irradiation with a boost to the posterior fossa.

References

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