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 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.

• 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.
• 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.
• The recommended chemotherapeutic regimen used for the management of standard risk medulloblastoma patients is a combination of lomustine and vincristine and cisplatin.

• The recommended chemotherapeutic regimen used for the management of high risk medulloblastoma patients is cyclophosphamide and vincristine and cisplatin
• Other chemotherapeutic agents used in the management of medulloblastoma patients include:

• Carboplatin
• Etoposide
• Temozolomide

References

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