Childhood Medulloblastoma Treatment

by National Cancer Institute

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There are different types of treatment for children with childhood medulloblastoma.

Different types of treatment are available for children with childhood medulloblastoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with medulloblastoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Your child's treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

• Neurosurgeon.
• Neurologist.
• Neuropathologist.
• Neuroradiologist.
• Rehabilitation specialist.
• Radiation oncologist.
• Medical oncologist.
• Endocrinologist.
• Psychologist.

Four types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood medulloblastoma as described in the General Information 3 section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Because radiation therapy can affect growth and brain development in young children, clinical trials are studying ways of using chemotherapy to delay or reduce the need for radiation therapy.

Cerebrospinal fluid diversion

Cerebrospinal fluid diversion is a method used to drain fluid that has built up around the brain and spinal cord. A shunt (long, thin tube) is placed in a ventricle (hollow space) of the brain and threaded under the skin to another part of the body, usually the abdomen. The shunt carries excess fluid away from the brain so it may be absorbed elsewhere in the body.

Other types of treatment are being tested in clinical trials.

High-dose chemotherapy with bone marrow transplantation or stem cell transplantation and radiation therapy

High-dose chemotherapy with bone marrow or stem cell transplantation is a method of giving high doses of chemotherapy and then replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Clinical trials are studying the use of this treatment followed by radiation therapy directed at the tumor only for childhood medulloblastoma.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Treatment Options for Childhood Medulloblastoma

Untreated Childhood Medulloblastoma

Untreated childhood medulloblastoma is a tumor for which no treatment has been given. The child may have received drugs or treatment to relieve symptoms caused by the tumor.

Standard treatment of average risk childhood medulloblastoma may include the following:

• Surgery.
• Radiation therapy to the brain and spinal cord with or without chemotherapy.
• A clinical trial of new combinations of radiation therapy and chemotherapy for children 3 years and older.

Standard treatment of poor risk childhood medulloblastoma may include the following:

• Surgery.
• Radiation therapy to the brain and spinal cord.
• Chemotherapy.

Standard treatment of childhood medulloblastoma in children younger than 3 years of age may include the following:

• Surgery with or without chemotherapy.
• Chemotherapy.
• Radiation therapy with or without chemotherapy.

Some of the treatments being studied in clinical trials for untreated childhood medulloblastoma in children younger than 3 years of age include the following:

• A clinical trial of chemotherapy to delay or reduce the need for radiation therapy.
• A clinical trial of high-dose chemotherapy with bone marrow transplantation followed by radiation therapy.
• A clinical trial of chemotherapy followed by surgery and radiation therapy.

Information about this and other ongoing clinical trials is available from the NCI Cancer.gov Web site.

Recurrent Childhood Medulloblastoma

Standard treatment of recurrent childhood medulloblastoma may include the following:

• Surgery with or without chemotherapy.

Some of the treatments being studied in clinical trials for recurrent childhood medulloblastoma include the following:

• A clinical trial of high-dose chemotherapy and bone marrow transplantation or peripheral blood stem cell transplantation with radiation therapy.
• A clinical trial of a new therapy.

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