Radiotherapeutic management of medulloblastoma

Although craniospinal irradiation has been employed in children with medulloblastoma for the past 40 years, many issues concerning its use have been raised and examined, and some continue to be debated. Careful radiation technique includes adequate irradiation of the neuraxis with special attention to the cribriform plate region and termination of the thecal sac. Conventional-dose craniospinal radiation therapy, in combination with chemotherapy, is currently recommended for patients with high-risk medulloblastoma. The appropriate dose of radiation to the craniospinal axis when this modality is combined with chemotherapy for low-risk medulloblastoma remains to be defined. Long-term results of hyperfractionated radiation therapy are likewise awaited. In an effort to decrease late toxicity to the immature central nervous system, radiation therapy can be delayed in a proportion of infants by administering chemotherapy after maximal tumor debulking.