Management of medulloblastoma involves:
- Acute management of raised intrancranial pressure with steroids and ventriculo-peritoneal shunt
- Surgical debulking of primary lesion
- Craniospinal Irradiation with boost to posterior fossa (doses depend on standard or high risk disease)
Acute Management
Patients should be started on dexamethasone to counter cerebral oedema. An urgent ventriculo-peritoneal shunt should be placed to relieve obstructive hydrocephalus.
Surgery
If possible, complete resection should be attempted - but only if safe to do so. The other main objective of surgery is to re-establish normal CSF flow from the third ventricle to the outer CSF resevoirs.
Chemoradiotherapy
For low and intermediate risk ('standard risk') patients are treated with craniospinal irradiation (23.4 Gy) followed by a boost to the primary site in the posterior fossa (additional 32.4 Gy in 16#).
High risk patients receive 36 Gy to the craniospinal axis (20 fractions) followed by a boost to the entire posterior fossa (additional 19.8 Gy in 11#)
Radiotherapy is given concurrently with vincristine.
Chemotherapy
Adjuvant chemotherapy (PCV) is prescribed at the completion of chemoradiotherapy.
