For patients with unresectable residual medulloblastoma in a location not amenable to further resection, which components of high risk treatment are most likely to benefit the patient?
Intensification components such as: 36 Gy CSI, Whole PF boost, concurrent carboplatin, pre-irradiation chemotherapy?
I had a recent case where I boosted the residual with careful attention to brainstem dose and added cisplatin after RT. I now have a patient (non-WNT, non-SHH) where that isn't possible due to location. The (adult) oncologist is not recommending platinum unless pt is group 3, which we won't know during RT. Which components of intensification would you use for such a patient?