Treatment options for childhood medulloblastoma

Medulloblastomas, infratentorial or cerebellar, primitive neuroectodermal tumors (PNETs) account for 20% of all childhood brain tumors and 40% of all cerebellar tumors 1, . Peak occurrence is at 4 years of age. Approximately 10% to 15% are diagnosed in infancy and require specific treatment approach . Treatment protocols are based on risk stratification, which takes into account age at presentation, residual disease [residual tumor at the primary site after surgery measured by postoperative gadolinium – enhanced magnetic resonance imaging (MRI)] as well as evidence of disseminated disease at the time of diagnosis. Patients older than 3 years of age with minimal residual disease (if postoperative MRI showed residual disease of 1.5 cm or less) are classified as an average risk group. Patients are defined as highrisk group if they had metastatic disease at the time of diagnosis (confirmed by gadolinium-enhanced MRI of the head and spine and if lumbar cerebrospinal fluid assessed after resection contained tumor cells); if they had residual disease of more than 1.5 cm (measured by postoperative gadolinium – enhanced MRI); if they are younger than 3 years of age at the time of diagnosis. Over the past decades there has been progressive improvement in the results of treatment of this group of patients with overall survival rates higher than 70% . There are several reasons for this which include advances in neuro-radiological imaging leading to more accurate localization, improvements in neuro-surgical techniques, better perioperative care, improvement in radiotherapy equipment and techniques including greater and more precise dosage delivered to the tumor and refinements in the timing and dosing of chemotherapy . Treatment options