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Recurrence of Medulloblastomas

The treatment for a medulloblastoma recurrence is based on whether the child has had craniospinal radiation as part of initial treatment.

Children who have had craniospinal radiation

Extensive use of radiation therapy will not be part of treatment if a child has had craniospinal radiation therapy before. However, in some cases a child may be given a small boost of radiation.

Surgery may be recommended. Surgery may be possible if the tumour has grown back in the same area and it has not spread.

The decision to use chemotherapy depends on the previous chemotherapy treatment, and on the condition of the child. Some children may be too weak for intense chemotherapy. Treatment for a recurrence will usually involve different chemotherapy drugs.

There is also some evidence that high-dose chemotherapy with peripheral stem cell support may be helpful, but it is unknown how many children will benefit.

Several factors predict a child’s response to chemotherapy:

  • Children whose recurrence is a long time from diagnosis tend to do better than children who relapse faster.
  • Children whose recurrence was detected in scans (subclinical recurrence), tend to do better than those whose recurrence was detected by symptoms (clinical recurrence).
  • Children with a single site of relapse will do better than those with multiple sites of relapse.

If the tumour is responding to chemotherapy, then the goal will be to continue treating to try and achieve a cure. However, the overall cure rate with this approach is still less than 5%.

If the recurrence is not responding to chemotherapy, the treatment team will discuss whether the focus needs to shift. If it appears that nothing is working, then the goal may become to manage pain and symptoms through palliative care.

Children who have not had craniospinal radiation

Infants with medulloblastoma are usually treated with chemotherapy initially to delay or avoid the use of radiation therapy.

When recurrence occurs, it means chemotherapy has failed and radiation may need to be considered as an option. To reduce the potential damaging impact of radiation, focal or localized radiation may be used with high-dose chemotherapy and peripheral stem cell support. This strategy has shown some success only with recurrences that have not spread (non-disseminated recurrences).

Eric Bouffet, MD, FRCPC