Medulloblastoma in Infants: The Critical Issues of the Dilemma

~Brain tumours have now become the leading cause of cancer death in children under the age of 18. Although advances in management have resulted in improvements in survival, pediatric oncologists face a number of challenges in dealing with childhood brain tumours, particularly when they affect younger patients. In an earlier issue of Current Oncology, Lafay– Cousin et al. reviewed a 22-year institutional experience of medulloblastoma management in infants and young children under the age of 3 years 1 . That series encompassed several eras during which significant changes occurred in the treatment of medulloblastoma. In the late 1980s, the Pediatric Oncology Group set a benchmark by using prolonged postoperative chemotherapy in an attempt to delay radiation in infants and young children with malignant brain tumours— including medulloblastoma 2 . The planned duration of chemotherapy was 24 months for children under 24 months of age and 12 months for children 24–36 months of age at diagnosis; the radiation therapy was started 3–4 weeks after the last cycle of chemotherapy. Although this cooperative effort was associated with significant hope and enthusiasm, the effectiveness of the strategy was soon questioned, because most enrolled children with medulloblastoma experienced early relapse (within the first 6–8 months of therapy). In addition, the incidence of late effect and second malignancy among survivors raised additional concerns 3 .