Medulloblastoma

[seper]

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What is the current evidence-based standard for concurrent chemotherapy with 23.4 Gy CSI for average-risk medulloblastoma?
none? vincristine? eitehr vincrisitne or cisplatin?

thx

 

[Gfunk6]

Concurrent vincristine followed by adjuvant PCV (platinum, CCNU, vincristine).

Evidence

However, based on institutional bias or patient co-morbidities, chemo can be modified. For boards I would say the above.

 

[Palex80]

However one has to point out, that there's another study out there showing bad results with reduced dose CSI + chemo:

http://www.ncbi.nlm.nih.gov/pubmed/7623725?dopt=Abstract

The Packer-trial results are impressive and have led to this therapy scheme becoming today's treatment standard, but it's still unclear, why other study groups have failed to reproduce these results.
Retrospective reviewers have suggested, that the study population included in Packer's-trial were very favorable "standard" risk medulloblastoma patients and that the problem with the European trial was giving chemotherapy first and radiation therapy later on, leading to radioresistant/repopulating tumor cells.

This is of course all theory, but I would keep these aspects in mind.