How do you manage a pediatric patient less than 3 years old with first relapse of medulloblastoma?

I am going to assume that this child was treated with high dose chemotherapy and no cranio-spinal irradiation prior to this progression since this is the most often used approach albeit not the only one.

As all practicing pediatric Neuro-oncologists are aware, this age group is one of the most challenging to treat due to the known sensitivity of medulloblastoma to radiation but, unfortunately, there is a significant risk of damage from CSI.

Several different factors are to be considered when planning the salvage therapy including the age of the patient, prior treatment and the toxicities from the therapy, site of relapse, time to relapse from completion of initial therapy, and, when possible, the molecular group of medulloblastoma.

A recent ...

I fully agree with Dr. @Dr. First Last. Please read the excellent paper from Erker et al., PMID 36548930. It contains a wealth of information (real life) that can help with the decision, including subgrouping.