Treatmentsfor Medulloblastoma

Neurosurgery is the first and primary treatment for medulloblastoma, if possible. This surgery aims to remove as much of the tumor as possible without causing more problematic symptoms for the child. Neurosurgery can also relieve the effects of hydrocephalus (a buildup of CSF that causes elevated pressure in the brain). Typically, an intraoperative MRI is used during neurosurgery to help remove the tumor safely. When a tumor is inoperable because of its location, other treatment options must be explored.

Radiation therapy uses high-energy rays to destroy cancer cells. Following surgery, it can be part of the treatment program for children with medulloblastoma. Radiotherapy is often administered to the brain and sometimes the spine, too. Our radiation oncologists have specialized techniques to determine the dose and volume of radiation so that it provides maximum benefits with minimal long-term effects for the overall health of the child. Because radiotherapy can interfere with the growth and development of a child’s brain and spine, alternate treatment options may sometimes be recommended.

Chemotherapy may be used to destroy remaining cancer cells after surgery for medulloblastoma. In general, chemo given in higher does is most effective when there is little tumor left after surgery. The standard guidelines are to use high-dose chemotherapy before or instead of radiation therapy for children under 3 or 4 years old; several sessions of chemo may be given after radiation therapy in children older than 3 or 4 years of age. Our pediatric specialists will customize the number of chemo sessions based on age, the subtype and extent of the disease.

Targeted therapy uses drugs to destroy cancer cells while causing minimal damage to normal, healthy cells. Signal transduction inhibitors (such as Vismodegib) are a specific type of targeted therapy that is currently used in clinical trials to treat recurrent medulloblastoma. These drugs block signals that are conveyed from one molecule to another inside a cell, thereby killing them.

A stem cell/bone marrow transplant may be used for children with recurrent medulloblastoma. In this medical procedure, the bone marrow that contains diseased cells is replaced by highly specialized stem cells that develop into healthy bone marrow. (Prior to the transplant, chemotherapy is generally used to kill all of the tumor cells in the bone marrow.) Only an autologous transplant, using the patient’s own stem cells, is typically used to treat medulloblastoma. Before performing a stem cell transplant, our pediatric specialists will consider several factors, such as age, overall health, the type of tumor, and the results of previous treatment.