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Medulloblastoma

Medulloblastoma. Patient Files Discussion. Surgery. Chemotherapy. Radiotherapy. CCSG. 25 Gy. High Dose Chemo. Hyperfraction. Thiotepa. Radiosurgery. 55Gy. High Risk. Low risk. Radiosensibilization. 35 Gy. Biopsy. Partial Removal. 18 Gy. BB SFOP. POG. VP 16 - Carbo.

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Medulloblastoma

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  1. Medulloblastoma Patient Files Discussion

  2. Surgery Chemotherapy Radiotherapy

  3. CCSG 25 Gy High Dose Chemo Hyperfraction Thiotepa Radiosurgery 55Gy High Risk Low risk Radiosensibilization 35 Gy Biopsy Partial Removal 18 Gy BB SFOP POG VP 16 - Carbo Bone Marrow Graft Sandwich Total removal SubTotal removal Maintenance Ventricuolocisternostomy SIOP Pilot study Vincristine Boost

  4. Low Risk = No Visible Tumor after surgery (Surgeon > post-op MR) High Risk = Visible Tumor (CSF, Metastasis, post-op residual tumor)

  5. S.N. 9 year-old girl • ICH • 2 months evolution

  6. Hydrocephalus Treatment > 3y. Total Removal = Low risk

  7. Hydrocephalus ? Protocol ? ±V°C° Total Removal Craniospinal Radiotherapy Chemotherapy (Vincristine) S.N 9y. > 3y. Total Removal = Low risk

  8. O.S 11year-old boy • Headaches, vomiting • Visual problem • Torticolis

  9. High Risk > 5 years

  10. High Risk > 5 years V°C° Biopsy 0.S. 9 years • Chemo (VP16 - Carbo) • Total Removal • High dose Chemo • CS Radiotherapy

  11. J.S 18 month-old girl • 1 month evolution • ICH, Macrocrania

  12. Low Risk < 5 years

  13. Low Risk < 5 years Total removal Chemo (BB SFOP) No RxT J.S 18 Months

  14. M.L 14 Month-old boy • 1993. • Macrocrania • Developmental regression • Anorexia

  15. High Risk < 5 years

  16. Partial removal VP 16 Carbo HD Chemo Removal of the metastasis Post.Fossa Irradiation M.L 14 months

  17. P.B 30 month-old boy • ICH • Torticoli

  18. High Risk < 5 years

  19. V°C° + Biopsy Chemo

  20. V°C° + Biopsy Chemo Surgery High dose Chemo X 5 + BMR PF Irradiation (50Gy) P.B 30 month-old boy High Risk < 5 years

  21. Standard Surgery ± Chemo Sandwich CS Radiotherapy Chemo Prospective Surgery Radiotherapy (Hyperfr.) and Chemotherapy Chemo Low Risk. > 3y Decrease the late complication oftreatment Overall Survival : 80%

  22. Standard Surgery Chemo (BB SFOP) If recurrence HD Chemo + BMR Radiotherapy (PF) Prospective New Chemo ? Low risk < 3 Years 40% without recurrence 3 years :90% EFS

  23. Standard Surgery ± Sandwich Chemo CS Radiotherapy Chemo Prospective V° + Biopsy Chemo (VP16 + Carbo x 2) Surgery High dose Chemo. CS Irradiation (35 & 50 Gy ?) High Risk > 3 years 5 y overall survival : 60% 5 y overall survival : 30%

  24. Standard ??? Prospective V° + Biopsy Chemo (VP16 + Carbo x 2) Surgery High dose Chemo. X 5 + BMG FP Irradiation (50 Gy) High Risk < 3 y 5 y overall survival : 0% 5 y overall survival : 30%

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