Medulloblastoma

Summary:

25/M, high risk medulloblastoma

Medulloblastoma

Nikhilesh Patil 03 Feb 2010 04:53

Your advice please:
25 yrs young Male, presented with raised ICT and ataxia, CT showed big (4x3cms) Posterior Fossa tumor, surgery, CSF- Negative. HPR Medulloblastoma, post op MRI residual lesion 2cms in size (high risk), MRI spine normal.
Radiation Treatment: CSI-What dose ? Boost to gross disease ? Total dose? Role of Chemo ?

Re: Medulloblastoma

vijaypgi 04 Feb 2010 15:54

CSi- 3600cGy/20#/4weeks,followed by posterior fossa boost to 1800Cgy/10#/2weeks.
So a total dose of 5400cGy to the gross diseases.
Should be offered concurrent chemotherapy with vincristine and adjuvant combination chemotherapy.

Re: Medulloblastoma

Santam Chakraborty 04 Feb 2010 19:07

Good answer

---

Re: Medulloblastoma

Srinivas Chilukuri 16 Feb 2010 17:55

my dose would be 36Gy/21# to CSI, 19.8Gy/11# boost to whole posterior fossa concurrent with VCR, followed by adjuvant ICE or nodified PCV protocol.
Please remember the rule of "peripheries"
If the surgery is done at a peripheral centre or if the residula disease is situated near periphery that is near cerebellum and not near 4th ventricle or brainstem, then reusrgery with skilled neurosurgeon would give the best results. Ofcourse if the surgeon was good then the residula disease should be stuch to brainstem and in that case the protocol mentioned above would do good. Now I have a sereis of patients with residual disease at the end of surgery most of them not near brainstem, all of them doing good with this protocol.

Re: Medulloblastoma

Nikhilesh Patil 16 Feb 2010 18:13

Thanks srinivas and vijay, this patient is being treated with supine CSI 36gy followed by boost, total dose 54 gy to posterior fossa, chemo is not offered as he has thrombocytopenia (BM-negative) right from day one and medical oncology guys did not want to do chemo.