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

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

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:

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:

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

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

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

↑ 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)