Summary
Following the introduction of CS-RT the survival rate for this malignant tumour rose from zero to approximately 50%. It appears that the major advances over the last twenty years associated with the introduction of CT/MRI, adequate staging, total resection, adjuvant therapy and improved radiation technique has only added 10–20% to the survival rate making it extremely difficult to evaluate the impact of these advances. While radiation treatment is currently omitted or delayed under the age of 36 months, due to enhanced neurocognitive toxicity, and replaced by maintained systemic therapy, the early encouraging results must stand the test of time in order to become standard practice. The treatment of a child with medulloblastoma with radiation treatment remains the corner stone of treatment while additional novel therapies are being developed.
Similar content being viewed by others
References
Paterson E: Treatment of cerebral tumours in children by irradiation. J Faculty of Radiologists 4: 175–179, 1953
Jenkin RDT: Medulloblastoma in childhood, radiation therapy. Canadian Med Assoc J 100: 51–53, 1969
Van Dyk J, Jenkin RDT, Leung PMK, Cunningham JR: Medulloblastoma: treatment technique and radiation dosimetry. Int J Radiation Oncology. Biol Phys 2: 993–1005, 1977
Carrie C, Alapetite C, Mere P, Aimard L, Pons A, Kollodie H, Seng S, Lagrange JL, Pontvert D, Pignon T, Lacroze M, Ginestet C, Bernard JL: Quality control of radiotherapeutic treatment of medulloblastoma in a multicentric study: The contribution of radiotherapy technique to relapse. Radiotherapy & Oncology 24: 77–81, 1992
Dunbar SF, Barnes PD, Tarbell NJ: Radiologic determination of the caudal border of the spinal field in cranial spinal irradiation. Int J Radiation Oncology Biol Phys 26: 669–673, 1993
Halperin EC: Concerning the inferior portion of the spinal radiotherapy field for malignancies that disseminate via the cerebral spinal fluid. Int J Radiation Oncology Biol Phys 26: 357–362, 1993
Jereb B, Sundaresan N, Herten B, Reid A, Galicich J: Supratentorial recurrences in medulloblastoma. Cancer 47: 806–809, 1981
Uozumi A, Yamaura A, Makino H, Miyoshi T, Arimizu N: A newly designed radiation port for medulloblastoma to prevent metastases to the Cribriform Plate Region. Child's Nerv Syst 6: 451–455, 1990
Jereb B, Krishnaswami S, Reid A, Allen J: Radiation for medulloblastoma adjusted to prevent recurrence to Cribriform Plate Region. Cancer 54: 602–604, 1984
Jenkin D, Goddard K, Armstrong D, Becker L, Berry M, Chan H, Doherty M, Greenberg M, Hendrick B, Hoffman H, Humphreys R, Sonley M, Weitzman S, Zipursky A: Posterior fossa medulloblastoma in childhood: Treatment results and a proposal for a new staging system. Int J Radiation Oncology Biol Phys 19: 265–274, 1990
Muller-Runkel R, Vijayakumar S: Spinal axis irradiation with electrons: Measurements of attenuation by the spinal processes. Med Phys 13: 539–543, 1986
Vijyakumar S, Muller-Runkel R: Medulloblastoma therapy using electron beams. Radiology 157: 541–542, 1985
Dewit L, Van Dam J, Rijnders A, Van De Velde G, Kian Ang K, Van Der Schueren E: Int J Radiation Oncology Biol Phys 10: 231–241, 1984
Gaspar LE, Dawson DJ, Tilley-Gulliford SA, Banerjee P: Medulloblastoma: Long term follow-up of patients treated with electron irradiation of the spinal field. Oncology 180: 867–870, 1991
Silverman CL, Simpson JR: Cerebellar medulloblastoma: The importance of posterior fossa, dose to survival and patterns of failure. Int J Radiation Oncology Biol Phys 8: 1869–1876, 1982
Hughes EN, Shillito J, Sallon SE, Loeffler JS, Cassady JR, Tarbell NJ: Medulloblastoma at the joint centre for radiation therapy between 1968 and 1984. Cancer 61: 1992–1998, 1988
Evans AE, Jenkin RDT, Sposto R, Ortega JA, Wilson CB, Wara W, Ertel IJ, Kramer S, Chang CH, Leikin SL, Hammond GD: The treatment of medulloblastoma. Results of a prospective randomized trial of radiation therapy with and without CCNU, Vincristine & Prednisone. J Neurosurg 72: 572–582, 1990
Tait DM, Thornton-Jones H, Bloom HJG, Lemerle J, Morris-Jones P: Ajuvant chemotherapy for medulloblastoma: The first multicentre controlled trial of the international society of paediatric oncology (SIOP I). Eur J Cancer 26: 464–469, 1990
Berry MP, Jenkin RDT, Keen CW, Nair BD, Simpson WJ: Radiation of medulloblastoma. A twenty-one year review. J Neurosurg 55: 43–51, 1981
Wara WM, Le QX, Sneed PK, Larsan DA, Prados MD, Levin VA, Edwards MSB, Wiel M: Int J Radiation Oncology Biol Phys 30: 551–556, 1994
Deutch M, Thomas P, Boyett J, Krischer JP, Finlay J, Kun L, Hammond D, Vietti T: Low stage medulloblastoma: A childrens cancer study group (CCSG) and paediatric oncology group (POG) randomized study of standard vs reduced neuraxis irradiation. Proc Ann Meet Am Soc Clin Oncol 10: A363, 1991
Neidhardt MK, Bailey CC: Prospective randomized cooperative medulloblastoma trial (MED84) of the International Society of Paediatric Oncology (SIOP) (German) Society of Paediatric Oncology (GPO). Childs Nerv Syst 3: 70–73, 1987
Gentet JC, Bouffet E, Doz F, Tron P, Roche H, Thyss A, Plantaz D, Stephan JL, Mottolese C, Ponvert D, Carrie C, Raybaud C, Brunat-Mentigny M, Choux M, Philip T, Zucker JM, Bernard JL: Pre-irradiation chemotherapy including ‘Eight Drugs in One Day’ regimens and high dose methotrexate in childhood medulloblastoma: results of the M7 French Cooperative Study. J Neurosurg 82: 608–614, 1995
Tomita T, McLone DG: Medulloblastoma in childhood: Results of radical resection and low-dose neuraxis radiation therapy. J Neurosurg 64: 230–242, 1986
Brand WN, Schneider PA, Tokars RP: Long term results of a pilot study of low dose cranial-spinal irradiation for cerebellar medulloblastoma. Int J Radiation Oncology Biol Phys 13: 1641–1645, 1987
Goldwein JW, Radcliffe J, Packer RJ, Sutton LN, Lange B, Rorke LB, A'Angio G: Results of a pilot study of low-dose craniospinal radiation therapy plus chemotherapy for children younger than five years with primitive neuroectodermal tumours. Cancer 71: 2647–2652, 1993
Packer RJ, Sutton LN, Goldwein JW, Perilongo G, Bunin G, Ryan J, Cohen BH, D'Angio G, Kramer ED, Zimmerman RA, Rorke LB, Evans AE, Schut L: Improved survival with the use of adjuvant chemotherapy in the treatment of medulloblastoma. J Neurosurg 74: 433–440, 1991
Packer RJ, Sutton LN, Elterman R, Lange B, Goldwein J, Nicholson HS, Mulne L, Boyett J, D'Angio G, Wechsler-Jentzsch K, Reaman G, Cohen BH, Bruce DA, Rorke LB, Malloy P, Ryan J, LaFond D, Evans AE, Schut L: Outcome for children with medulloblastoma treated with radiation and cisplatin, CCNU and vincristine chemotherapy. J Neurosurg 81: 690–698, 1994
Halberg FE, Wara W, Fippin LF, Edwards MSB, Levin VA, Davis RL, Prados MB, Wilson CB: Low-dose craniospinal radiation therapy for DV medulloblastoma. Int J Radiation Oncology Biol Phys 651–654, 1991
Gnekow AK, Bailey C, Machaelis J, Wellek S, Kleihues P: SIOP/GPO medulloblastoma trial. Med'84: Med Ped Oncol 18: 426 (Abstract 224), 1990
Bouffet E, Bernard JL, Frappaz D, Gentet JC, Roche H, Tron P, Carrie C, Raybaud C, Joannard A, Lapras C, Choux N, Carton M, Aimard L, Philip T, Brunat-Mentingy M: M4 protocol for cerebellar medulloblastoma: supratentorial radiotherapy may not be avoided. Int J Radiation Oncology Biol Phys 24: 79–85, 1992
Krischer JP, Ragaba H, Kun L, Kim TH, Laurent JP, Boyett JM, Cornell CJ, Link M, Luthy A, Camitta B: Nitrogen mustard, vincristine, procarbazine and prednisone as adjuvant chemotherapy in the treatment of medulloblastoma. A paediatric oncology group study. J Neurosurg 74: 905–909, 1991
Zeltzer P, Boyett J, Finlay J, Albright L, Wisoff J, Geyer R, McGuire P, Allen J, Rorke L, Stanley P, Stehbens J, Stevens K, Shurin S, Milstein J, Packer R, Bleyer A: Prognostic factors for survival in high risk primitive neuroectodermal tumours (PNET) in children: report from the childrens cancer group. Proceedings ASCO 12: 415, Abstract 1425, 1993
Attard-Montalto S, Plowman N, Breatnach F, Saha V, Eden OB: Is there a danger in delaying the radiotherapy in childhood medulloblastoma? The British Journal of Radiology 66: 807–813, 1993
Scolfield DE, Yunis EJ, Geyer JR, Albright AL, Berger MS, Taylor SR: DNA content and other prognostic factors in childhood medulloblastoma. Cancer 69: 1307–1314, 1992
Garson JA, Pemberton LF, Sheppard PW, Varndelli N, Coakham HB, Kemshead JT: N-myc gene expression and oncoprotein characterization in medulloblastoma. Br J Cancer 59: 889–894, 1989
Bigner SH, Friedman HS, Vogelstein B, Oakes WJ, Bigner DD: Amplification of the c-myc gene in human medulloblastoma cell lines and xenografts. Cancer Research 50: 2347–2350, 1990
Zerbini C, Gelber RD, Weinberg D, Sallan S, Barnes P, Kupsky W, Scott RM, Tarbell NJ: Prognostic factors in medulloblastoma, including DNA ploidy. J Clin Oncol 11: 616–622, 1993
Tait DM, Eeles RA, Carter R, Ashley S, Ormerod MG: Ploidy and proliferative index in medulloblastoma: Useful prognostic factors? Eur J Cancer 29A: 1383–1387, 1993
Gilbertson RJ, Jarose B, Perry RH, Pearson ADJ: Prognostic factors in medulloblastoma. Lancet 480,1992
Roberts RO, Lynch CF, Jones MP, Hart MN: Medulloblastoma: A population based study of 532 cases. J Neuropath Exper Neurology 50: 134–144, 1991
Stiller CA, Lennox EL: Childhood medulloblastoma in Britain 1971–77: Analysis of treatment and survival. Br J Cancer 48: 835–841, 1983
Bourne JP, Geyer R, Berger M, Griffin B, Milstein J: The prognostic significance of post-operative residual contrast enhancement on CT scan in paediatric patients with medulloblastoma. J Neuro-Oncology 14: 263–270, 1992
Duffner PK, Horowitz ME, Jeffrey MD, Krischer P, Friedman HS, Burger PC, Cohen ME, Sanford RA, Mulhern RK, James HE, Freeman CR, Seidel FG, Kun LE: Post-operative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumours. N Engl J Med 328: 1725–1731, 1993
Geyer JR, Zeltzer PM, Boyett JM, Rorke LB, Stanley P, Albright AL, Wisoff JH, Milstein JM, Allen JC, Finlay JL, Ayers GD, Shurin SB, Stevens KR, Bleyers WA: Survival of infants with primitive neuroectodermal tumors or malignant ependymomas of the CNS treated with eight drugs in 1 day: a report from the childrens cancer group. J Clin Oncol 12: 1607–1615, 1994
Gajjar A, Mulhern RK, Heideman RL, Sanford RA, Douglas EC, Kovnar EH, Langston JA, Jenkins JJ, Kun LE: Medulloblastoma in very young children: outcome of definitive craniospinal irradiation folllowing incomplete response to chemotherapy. J Clin Oncology 12: 1212–1216, 1994
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jenkin, D. The radiation treatment of medulloblastoma. J Neuro-Oncol 29, 45–54 (1996). https://doi.org/10.1007/BF00165517
Issue Date:
DOI: https://doi.org/10.1007/BF00165517