Current treatment approaches to early childhood medulloblastoma

Abstract

Treatment of medulloblastoma, the most common malignant brain tumor of childhood, is particularly challenging in very young children, owing to the increased susceptibility of the immature brain to treatment-induced neurocognitive deficits. Three promising strategies have been developed in combination with systemic postoperative chemotherapy, to avoid craniospinal irradiation for young children with nonmetastatic medulloblastoma, these include: high-dose chemotherapy, with and without local radiotherapy; intraventricular chemotherapy; and local radiotherapy. More intensified strategies may be required for metastatic medulloblastoma. Future studies will clarify the prognostic relevance of desmoplasia, postoperative residual tumor and biological markers to improve stratification criteria by risk-adapted treatment recommendations. An international Phase III trial for young children with nonmetastatic medulloblastoma, comparing survival rates and neurocognitive outcomes of different treatment strategies by standardized criteria, is under discussion.

Antiglioma effects of cytarabine on leptomeningeal metastasis of high-grade glioma by targeting the PI3K/Akt/mTOR pathway

“…In the German HIT-SKK’92 trial, 10-year PFS rate was 82% for patients who had no postoperative residual tumor and 50% for patients with residual tumors 44. These findings were favorable compared with 29%–41% 5-year PFS rates observed in previous studies that excluded CSF-directed chemotherapy 45. Based on encouraging results of CSF-directed chemotherapy at the initial treatment of medulloblastoma, similar benefits may be observed by incorporating CSF-directed therapy into the initial treatment of high-grade glioma for LM prevention and therapy.…”

A Rare Case of Medulloblastoma Coexisting with Multiple Spinal Intramedullary Tumors

“…Recently, the intrathecal route of drug administration has been developed, which is easy, painless and safe for drug administration and improved drug distribution in the CSF. In preschool children with favorable presentations (nonmetastatic, completely resected, desmoplastic histology), survival rates also exceed 70% in the recently reported studies [11] using both low- and high-intensity chemotherapy schedules with or without intrathecal methotrexate and with or without involved field radiotherapy.…”

“…Spinal seedling at presentation was a poor prognostic factor for recurrence for the studied pediatric patients. Older children have better survival rates (60-80%) than children less than 3 years (25-45%) with medulloblastoma [11]. According to a study published by St. Jude Children's Research Hospital, 5-year event-free survival for 48 high-risk medulloblastoma patients was 70%.…”

Current Treatment Approaches for Infants with Malignant Central Nervous System Tumors

“…International cooperative efforts will require prior consensus on common and realistic methods for evaluating the neurocognitive and functional status of survivors. To be successful and to overcome linguistic and cultural barriers, these tests will need to be simple, sensitive, and reproducible [46]. Once survival rates have been consistently raised, the quality of neurocognitive and overall function of survivors might become the primary objective of future studies.…”