Medulloblastoma treatment

Medulloblastoma is a malignant tumor that most often occurs in childhood. It is one of the most common malignant brain tumors in children.

Medulloblastomas form in the cerebellum, which is the part of the brain located at the base of the skull, just above the brain stem. The cerebellum performs many functions, including coordinating voluntary movements (e.g., walking, fine motor skills) and regulating balance and posture.

Medulloblastomas arise from primitive, undeveloped brain cells. Therefore, they are classified as primitive neuroectodermal tumors. However, recent studies show that these tumors are more similar to embryonic tumors. Understanding the nature of the tumor allows a more precise approach to possible treatment options.

The exact cause of medulloblastoma is unknown. In many cases, medulloblastoma is associated with chromosomal abnormalities. These abnormalities are not inherited, but occur at an undetermined point in a child’s development.

In about one-third of patients with medulloblastoma, tumor cells may have a specific chromosomal abnormality known as isochromosome 17q, with concomitant loss or inactivation of some genetic information.

Cancer patients, including medulloblastoma, may also have abnormal changes in oncogenes or suppressor genes. Oncogenes suppress the tumor, control cell division and ensure timely cell death. Oncogenes that are associated with medulloblastoma include ERBB2, MYCC, and OTX2.

About 5% of medulloblastoma cases are associated with one of these syndromes:

• Familial adenomatous polyposis – sometimes known as Turco syndrome,
• Basal cell nevus syndrome (Gorlin syndrome).

As it grows, the tumor can press on the surrounding structures of the brain and cause these symptoms:

Headaches, occurring mostly in the morning and evening.

• Nausea,
• Vomiting,
• Shakiness when walking,
• Dizziness,
• Double vision.
• Clumsiness.

Medulloblastoma diagnosed in a child is usually divided into standard-risk and high-risk tumors.

Standard-risk tumor

In standard-risk, the tumor is in the posterior cranial fossa and does not spread to other parts of the brain and spinal cord. brain. In addition, it is almost completely removed during surgery, meaning that less than 1.5 cubic centimeters (cm) of tumor remains after surgery.

During molecular screening, standard-risk tumors do not identify abnormalities and abnormalities that could worsen the prognosis of the disease.

High-risk tumor.

The risk is high if the tumor has spread beyond the primary location to other parts of the brain and spinal cord, or has not spread, but more than 1.5 cc of tumor remains after surgery.

Some tumors that are initially defined as standard-risk tumors may have the molecular and genetic characteristics of a high-risk tumor.
Information about tumor risk classification will help your doctor develop the most effective treatment plan.

Specialists divide medulloblastoma into several types, depending on their structure. The structure of tumor cells is studied under a microscope. These types of medulloblastoma are distinguished:

• Classic medulloblastoma. This variant occurs in 8 out of 10 patients,
• Anaplastic or large cell medulloblastoma,
• Nodular or desmoplastic medulloblastoma – this type is most common in infants,
• Brain blastoma with extensive nodulation.

Based on molecular and genetic studies, each type of medulloblastoma is also divided into 4 subtypes.

This extensive division and classification of medulloblastoma gives doctors a broad understanding of the nature and internal processes of medulloblastoma. This helps improve existing treatment protocols and develop new ones.

Multidisciplinary approach

The treatment of a patient with medulloblastoma is performed jointly by a team of experienced specialists. Treatment involves a medical oncologist, radiotherapist, chemotherapist, and surgeon.

Specialists improve their qualifications every year and take internships at reputable medical centers.

Large, multidisciplinary medical centers employ doctors of all specialties. This means that a patient may receive consultation from any narrow disciplinary specialist, if necessary.

High-tech equipment

In most foreign clinics, the patient has access to the most modern equipment, which makes diagnosis more accurate and treatment more effective.

In such medical centers one can undergo proton therapy, surgery on the Da Vinci robotic system or receive a course of radiation therapy on the Varian Edge apparatus (TrueBeam gas pedal).

For surgical treatment of medulloblastoma abroad, neuroendoscopic methods are used. Surgeries are performed minimally invasively, through several small punctures with an endoscope. The precision of the operation is ensured by neuronavigation systems, which show the tumor location and all the surgeon’s manipulations in real time.

Modern treatment protocols

Foreign medical centers use current treatment protocols from the U.S., Europe and Israel, including American protocols developed by the National Comprehensive Cancer Network (NCCN).

When developing an individual treatment plan, much attention is given to supportive care, which stabilizes the overall condition of the patient and reduces the negative effects of radiation and chemotherapy.

Medulloblastoma is one of the few tumors of the central nervous system that metastasizes. Metastases spread along the outflow path of the cerebrospinal fluid.

Typically, secondary tumors form in the dura mater and inner surface of the brain ventricles. In rare cases, medulloblastoma may metastasize to the bones, lungs, and liver.