Bevacizumab and stereotactic radiosurgery achieved complete response for pediatric recurrent medulloblastoma

Recurrent medulloblastoma has a very poor prognosis in children regardless of the treatment employed. We report the case of a 3-year-old child with recurrent refractory medulloblastoma who was treated with both bevacizumab and stereotactic radiosurgery (SRS). The boy was found to harbor a tumor in the cerebral posterior fossa in November 2010. Craniotomy was performed to remove the tumor completely. Postoperative pathological examination showed desmoplastic medulloblastoma. Craniospinal radiotherapy and chemotherapy were performed. Three years later, the boy suffered from constant headache again. Magnetic resonance imaging showed seeding of medulloblastoma in the posterior fossa as four masses with diameter ranging from 2 cm to 3 cm. To avoid overdose radiation, we used SRS and anti-angiogenesis therapy. Bevacizumab was given at 10 mg/kg for four times with an interval of 1 month. Gamma Knife (Leksell Gamma Knife^®, Elekta Instruments, Stockholm, Sweden) was used targeting at one lesion each time and performed for consecutive two times with bevacizumab therapy. Following this combined treatment, the lesions targeted with radiosurgery showed complete response with minimal toxicity in <1 month successively. The combined use of bevacizumab and SRS may represent a novel treatment against medulloblastoma in patients who are not surgical candidates, and should be investigated further. This is the first documented case of medulloblastoma treated with bevacizumab and SRS. Further clinical trials should be considered to evaluate the effectiveness of this strategy.