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Medulloblastoma: optimizing care with a multidisciplinary approach

Authors Thomas A, Noël G

Received 14 September 2018

Accepted for publication 11 February 2019

Published 30 April 2019 Volume 2019:12 Pages 335—347


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Alice Thomas,1 Georges Noël1,2

1Radiotherapy Department, Centre Paul Strauss, UNICANCER, F-67065 Strasbourg, France; 2Radiobiology Lab, CNRS, IPHC UMR 7178, Centre Paul Strauss, UNICANCER, F-67000 Strasbourg, France

Abstract: Medulloblastoma is a malignant tumor of the cerebellum and the most frequent malignant brain tumor in children. The standard of care consists of maximal resection surgery, followed by craniospinal irradiation and chemotherapy. Such treatment allows long-term survival rates of nearly 70%; however, there are wide disparities among patient outcomes, and in any case, major long-term morbidity is observed with conventional treatment. In the last two decades, the molecular understanding of medulloblastoma has improved drastically, allowing us to revolutionize our understanding of medulloblastoma pathophysiological mechanisms. These advances led to an international consensus in 2010 that defined four prognostic molecular subgroups named after their affected signaling pathways, that is, WNT, SHH, Group 3 and Group 4. The molecular understanding of medulloblastoma is starting to translate through to clinical settings due to the development of targeted therapies. Moreover, recent improvements in radiotherapy modalities and the reconsideration of craniospinal irradiation according to the molecular status hold promise for survival preservation and the reduction of radiation-induced morbidity. This review is an overview of the current knowledge of medulloblastoma through a molecular approach, and therapeutic prospects currently being developed in surgery, radiotherapy and targeted therapies to optimize the treatment of medulloblastoma with a multidisciplinary approach will also be discussed.

Keywords: molecular subgroup, targeted therapies, radiotherapy, proton therapy

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