How are medulloblastomas treated?
Medulloblastoma is the most common high grade childhood tumour, accounting for 15-20% of all childhood brain tumours.
Medulloblastomas are commonly found in children between ages of three and eight, with a higher occurrence in males. They usually develop in a part of the brain called the posterior fossa, and may sometimes spread to other parts of the brain or spinal cord.
Types of medulloblastoma
In the past few years, our understanding of medulloblastoma has advanced significantly by studying their genetic make-up and increasing our molecular understanding of this tumour type.
Researchers have now been able to identify that medulloblastoma can be subgrouped in to four main groups that have been defined by demographic, clinical and genetic differences. They are:
- Wnt medulloblastoma
- SHH medulloblastoma
- Group 3 medulloblastoma
- Group 4 medulloblastoma
What are the treatments for medulloblastoma?
The initial treatment for a child diagnosed with a medulloblastoma is surgery to remove the tumour. To remove as much of your child’s tumour as possible, the neurosurgeon needs to have greater access to your child’s brain. During surgery a ‘bone flap’ will be removed from your child’s skull.
This type of operation is known as a ‘craniotomy’.
However, if your child’s tumour has caused a build-up of CSF, the surgeon may firstly need to perform an urgent operation to divert the flow of fluid to the abdomen, to reduce the pressure. There are different ways this can be done, from inserting a small, temporary drain, a more permanent shunt or a camera procedure to make a hole at the bottom of the brain (also known as a ventriculostomy). If a shunt is inserted, it may stay in place after surgery to prevent future fluid build-up.
Following surgery, radiotherapy is often used to destroy any remaining tumour cells. It is normally given to the whole brain and spinal cord as this tumour type may travel through the CSF to the spinal cord. However, if a child is aged under three, whole brain radiotherapy is avoided.
In children under three, high-dose chemotherapy may be used to delay or eliminate the need for radiotherapy. In children older than three, several cycles of high-dose chemotherapy may be given before or after radiotherapy.
Chemotherapy drugs destroy tumour cells by stopping their ability to grow and divide, hence reducing the risk of them spreading through the spinal fluid.
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