Treatment

Treatment of medulloblastoma is maximal surgical excision with external beam irradiation to the posterior fossa and craniospinal axis. Pre-operative ventriculo-peritoneal shunts may be employed but provide a potential route for tumour seeding, especially to bone.

Presymptomatic craniospinal irradiation may be practised to reduce the incidence of tumour recurrence distant to the primary site, but it is associated with neurocognitive dysfunction, growth retardation and myelosuppression, and endocrine disorders. It is excluded from children less than 18 months of age since the immature infant is very intolerant of radiation.

Adjuvant chemotherapy using vincristine, CCNU and cisplatin have been used

Prognosis

• the last 30 years have seen significant improvements in overall survival, at around 80% for patients with average risk (children >3 years of age, less than 1.5 cm2 of residual disease in the primary site, and absence of metastatic disease) and 60%-70% for high-risk patients (those with bulky residual disease, brain stem invasion, and neuraxis metastasis) with the use of standard chemotherapy and radiotherapy (craniospinal irradiation and focal boost)

Reference:

• Pui CH, Gajjar AJ, Kane JR, Qaddoumi IA, Pappo AS. Challenging issues in pediatric oncology. Nat Rev Clin Oncol. 2011;8:540-549
• Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10-29.