ON THIS PAGE: You will learn about the different treatments doctors use for children with medulloblastoma. Use the menu to see other pages.
In general, brain tumors in children are uncommon. This means it can be hard for doctors to plan treatment unless they know what has been most effective in other children. That is why more than 60% of children with cancer are treated as part of a clinical trial. A clinical trial is a research study that tests a new approach to treatment. The “standard of care” is the best treatments known. Clinical trials may test such approaches as a new drug, a new combination of existing treatments, or new doses of current therapies. The health and safety of all children participating in clinical trials are closely monitored.
To take advantage of these newer treatments, children with a brain tumor should be treated at a specialized medical center. Doctors at these centers have extensive experience in treating children and have access to the latest research. A doctor who specializes in treating children with cancer is called a pediatric oncologist. If a pediatric cancer center is not nearby, general cancer centers sometimes have pediatric specialists who are able to be part of your child’s care.
In many cases, a team of doctors works with a child and the family to provide care. This is called a multidisciplinary team. Pediatric cancer centers often have extra support services for children and their families, such as child life specialists, dietitians, physical and occupational therapists, social workers, and counselors. Special activities and programs to help your child and family cope may also be available.
The main types of treatment used to treat medulloblastoma include surgery, radiation therapy, and chemotherapy. Current treatment plans tailor treatment recommendations based on the molecular subgroup of medulloblastoma. Sometimes, the treatments are used in combination. In some situations, stem cell or bone marrow transplantation may be recommended.
Descriptions of the common types of treatments used for medulloblastoma are listed below. Your child’s care plan also includes treatment for symptoms and side effects, an important part of medical care. Treatment options and recommendations depend on several factors, including the type and stage of the tumor, possible side effects, the family’s preferences, and the child’s overall health.
Take time to learn about your child’s treatment options and be sure to ask questions about things that are unclear. Talk with your child’s doctor about the goals of each treatment and what your child can expect while receiving the treatment. These types of talks are called "shared decision making." Shared decision making is when you and your child's doctors work together to choose treatments that fit the goals of your child's care. Shared decision making is particularly important for medulloblastoma because there are different treatment options. Learn more about making treatment decisions.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Most commonly, it is the first treatment used for medulloblastoma. In addition to removing or reducing the size of the tumor, surgery can provide a tissue sample to diagnose the tumor, as explained in the Diagnosis section.
Surgery to the brain requires the removal of part of the skull, a procedure called a craniotomy. After the surgeon removes the tumor, the patient’s own bone will be used to cover the opening in the skull. There have been rapid advances in surgery for brain tumors. This includes the use of enhanced imaging machines to give surgeons more tools to plan and perform the surgery and cortical mapping. Cortical mapping is a technique that allows doctors to identify certain areas of the brain that control the senses, language, and motor skills.
Some tumors cannot be removed by surgery because of their location. These tumors are called inoperable. In these situations, the doctor will recommend other treatment options. If the tumor is cancerous, even if the cancer cannot be cured, removing it can relieve symptoms caused by the tumor pressing on the brain.
Side effects from surgery for medulloblastoma can vary. Occasionally the surgeon will place a plastic tube called a shunt to move the fluid made inside the brain to the abdomen so that the fluid does not build up in the brain and cause problems. In most instances, the placement of a shunt is safe and most children do not have any problems from the procedure.
Before surgery, talk with the health care team about the possible side effects from the specific surgery your child will have. Learn more about the basics of surgery.
Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
A type of radiation therapy that may be used for medulloblastoma is proton therapy. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy tumor cells. Proton therapy is becoming more widely used in the United States.
Because radiation therapy can sometimes interfere with the growth and development of a child’s brain and spine, the doctor may choose to treat the tumor in another way. If radiation therapy is recommended, the approach will be based on the child’s age and the features of the tumor (see Stages):
For children older than 3, radiation therapy is given to the entire brain and spine, followed by radiation therapy aimed directly at the tumor and the surrounding area or the back part of the brain.
For children younger than 3, radiation therapy may be directed only to the back part of the brain or the tumor and the surrounding area after surgery and chemotherapy (see below).
Short-term side effects from radiation therapy may include fatigue, mild skin reactions, vomiting, and loss of appetite. Most of these side effects go away soon after treatment is finished. Long-term side effects of radiation therapy may include problems with growth, low hormone levels, and problems with learning, especially higher education.
Learn more about the basics of radiation therapy.
Chemotherapy is the use of drugs to destroy tumor cells, usually by keeping the tumor cells from growing, dividing, and making more cells.
It can also be given by injection into a muscle or directly into the cerebrospinal fluid. This is fluid that circulates around the brain and spinal cord.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.
Researchers are studying ways to use chemotherapy before, during, or after radiation therapy, as the 2 types of treatment may work better to treat medulloblastoma when combined.
Chemotherapy given in higher doses works best when there is little tumor left after surgery. When and how chemotherapy may be used is based on a child’s age:
High-dose chemotherapy may be used before or instead of radiation therapy for children younger than 3 to 4 years old.
Several cycles of chemotherapy may be used after radiation therapy in children older than 3 to 4 years old.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.
The medications used to treat a brain tumor are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for you/your child, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with medications to treat the tumor. Learn more about your child’s prescriptions by using searchable drug databases.
Learn more about the basics of chemotherapy.
Bone marrow transplantation/stem cell transplantation
A bone marrow transplant may be used for children with recurrent medulloblastoma. A stem cell transplant is a medical procedure in which bone marrow that contains tumor cells is replaced by highly specialized cells. These cells, called hematopoietic stem cells, develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant. This is because it is the stem cells in the blood that are typically being transplanted, not the actual bone marrow tissue.
Before recommending transplantation, doctors will talk with you about the risks of this treatment. They will also consider several other factors, such as the type of tumor, results of any previous treatment, and your child’s age and general health.
There are 2 types of stem cell transplantation depending on the source of the replacement blood stem cells: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO uses the patient’s own stem cells. Only AUTO transplantation is commonly used to treat medulloblastoma. ALLO transplantation is rarely recommended for children with medulloblastoma.
The goal is to destroy all of the tumor cells in the bone marrow, blood, and other parts of the body using high doses of chemotherapy and/or radiation therapy and then allow replacement blood stem cells to create healthy bone marrow.
Side effects depend on the type of transplant, your child’s general health, and other factors. Learn more about the basics of bone marrow transplantation and stem cell transplantation.
Physical, emotional, and social effects of medulloblastoma
Medulloblastoma and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your child’s care that is included along with treatments intended to slow, stop, or eliminate the tumor.
Palliative care focuses on improving how your child feels during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of disease, may receive this type of care. And it often works best when it is started right after a diagnosis. People who receive palliative care along with treatment for the tumor often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the tumor, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your child’s doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
During treatment, your child’s health care team may ask you to answer questions about your child’s symptoms and side effects and to describe each problem. Be sure to tell the health care team if your child are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.
Remission and the chance of recurrence
A remission is when the tumor cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the tumor will come back. While many remissions are permanent, it is important to talk with your child’s doctor about the possibility of the tumor returning. Understanding your child’s risk of recurrence and the treatment options may help you feel more prepared if the disease does return. Learn more about coping with the fear of recurrence.
If the tumor returns after the original treatment, it is called a recurrent tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your child’s doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, radiation therapy, or chemotherapy, but they may be used in a different combination or given at a different pace. Your child’s doctor may suggest clinical trials that are studying new ways to treat this type of recurrent tumor. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
Treatment of recurrent medulloblastoma depends on 2 factors:
Whether the tumor recurred in the place where it began or in another part of the brain
The type of treatment the child received for the original tumor
Depending on each child’s situation, the doctor may recommend surgery, radiation therapy, chemotherapy, and/or stem cell/bone marrow transplantation. High-dose chemotherapy may be a part of treatment for children with recurrent medulloblastoma. Salvage chemotherapy refers to the use of chemotherapy for a patient who experiences a recurrence of cancer following initial treatment, in the hope of providing a cure or prolonging life.
If your child is diagnosed with a recurrence, you and your family may experience emotions such as disbelief or fear. You are encouraged to talk with your child’s health care team about these feelings and ask about support services to help your family cope. Learn more about dealing with a recurrence.
If treatment does not work
Although treatment is successful for most children with a brain tumor, sometimes it is not. If a child’s tumor cannot be cured or controlled, this is called advanced or terminal medulloblastoma. This diagnosis is stressful, and advanced medulloblastoma may be difficult to discuss. However, it is important to have open and honest conversations with your child’s health care team to express your family’s feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help.
Hospice care is designed to provide the best possible quality of life for people who are expected to live less than 6 months. Parents and guardians are encouraged to talk with the health care team about hospice options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Some children may be happier if they can attend school part-time or keep up other activities and social connections. The child’s health care team can help parents or guardians decide on an appropriate level of activity. Making sure a child is physically comfortable and free from pain is extremely important as part of end-of-life care. Learn more about caring for a terminally ill child and advanced care planning.
The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Learn more on grieving the loss of a child.
The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for children with medulloblastoma. Use the menu to choose a different section to read in this guide.