For a recurrent medulloblastoma in the posterior fossa several years after initial standard risk therapy (23.4 Gy CSI), and in which the patient is still less than 18, how would you approach re-irradiation?
Assuming CSF is negative for neoplastic cells would you:
Re-irradiate gross disease only?
Re-irradiate posterior fossa only?
Re-irradiate the entire CSA with posterior fossa boost?
Does a multifocal recurrence in the posterior fossa and brainstem change your recommendation?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · University of Washington Medical Center
Answered on
If the recurrences are localized to the resection bed, I would re-irradiate only the recurrences (and possibly the entire resection bed depending on number of recurrences). If there is evidence of CSF dissemination (recurrences not associated with primary--whether in posterior fossa or not) then CSI...
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Mednet MemberInvited Expert
Radiation Oncology · NCI Radiation Research Program and Radiation Oncology Branch
Answered on
This is my approach.
Short version: it depends on a lot and no answer on a website can do this situation justice. This is not a good situation and will likely not end well.
Long version: In reality is very case by case (will repeat this on purpose) - patient and family inputs are invaluable. If the...
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