Overview on the treatment of medulloblastoma to the child

Abstract

The tumors of the central nervous system (CNS) are the most frequent solid tumors of the children occupying the second place after leukemia for all the malignancy of the child. Of primary brain tumors in children, more than one half originate in the posterior fossa. Medulloblastoma (MB) are highly malignant tumors representing the most common malignant posterior fossa tumor in the pediatric population, accounting for nearly 20% of all childhood brain tumors and 40% of those arising below the tentorium. This embryonic tumor is histological characterized by small, round to oval cells with hyperchromatic nuclei surrounded by a minimal degree of cytoplasm. MB's are characterized by their tendency to seed along the neuraxis, following cerebrospinal fluid (CSF) pathways, and they represent one of the few brain tumors, including ependymoma, pinealoblastoma, and lymphoma, to metastasize to extraneural tissues (bone, bone marrow, lymph nodes, liver).
The incidence of MB is 1.5-2 cases per 100,000 populations, and the peek in incidence of the MB's between 3 and 5 years, although it can occur throughout childhood and until adult. In Romania the incidence of the CNS tumors to the child is not known. Each year about 70 children with tumors of CNS (mortality = 1.3o/oooo under 19 years) die in our country and this result is the same in the last two decades. The last 20 years have registered advances in establishing of the diagnosis (imaging), in the neurosurgery, neuroanaesthesia and intensive care. New techniques of radiotherapy have been developed (hyperfractionated, three-dimensional, conformational radiotherapy (3DCT), intensity modulated radiotherapy (IMRT), stereotactical radiotherapy, stereo tactical radio surgery (Gamma Knife), irradiation with protons). New chemotherapeutical protocols have offered a better systemic control of the disease. So the survival rates grew every decade. Cure can be reached, but the price for almost all the patients is a poor quality of life (motor, neurocognitive, hearing, visual, endocrinological and social).