Medulloblastoma Treatment
At MD Anderson, medulloblastoma treatment is carefully designed by a team of highly specialized experts. Our world-renowned neurosurgeons, neuropathologists, neuro-oncologists, neuroradiologists and radiation oncologists work together to develop a customized care plan centered on each patient¡¯s specific treatment needs. They take a team approach to deliver the most advanced therapies with the fewest possible short- and long-term side effects, keeping a constant eye on the patient¡¯s quality of life.
Each patient is also cared for by a specially trained staff of nurses, therapists and other care professionals. For pediatric patients, this team remains with your child from diagnosis through follow-up, providing consistency and peace of mind.
Leading Advancements in Treatment
Advanced technologies and less-invasive treatment options, such as proton therapy, BrainSuite (intraoperative MRI) and new targeted therapies provide the best hope for successful treatment with the least impact on physical and mental function.
We are also pioneering the use of immunotherapy, which unleashes the body's own immune system against disease, as a treatment for recurrent medulloblastoma. In addition, we conduct a wide range of clinical trails, including trials targeted therapies and minimally invasive procedures that deliver medications directly to the tumor.
Thanks to advanced treatments, more than two-thirds of children with medulloblastoma can be treated successfully. Many adults are also successfully treated.
However when the disease recurs, treatment can be challenging and have less chance of success. Teams with both the Children¡¯s Cancer Hospital and Brain and Spine Center specialize in treating relapsed brain tumors, including medulloblastoma. This focused, multidisciplinary approach is critical achieving the best possible results.
Our medulloblastoma treatments
Medulloblastoma treatment is customized based on several factors, including, the patient¡¯s age and health, the size and location of the tumor, and whether the cancer has spread to other parts of the nervous system or the body. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Medulloblastoma surgery
Medulloblastoma treatment almost always includes surgery to remove as much of the tumor as possible as safely as possible to minimize damaging the surrounding brain tissue. Studies have shown that if doctors remove more of the tumor, the chances for successful treatment and improved survival are better.
In addition, surgery may be required to treat a condition called hydrocephalus. This occurs when the tumor blocks the cerebral spinal fluid (CSF) surrounding the brain and spine. In this situation, doctors may perform a procedure to divert the CSF.
Like all surgeries, brain tumor surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. This is especially true with brain tumors, because it is crucial to remove as much of the tumor as possible while leaving intact as much brain function as possible.
Neurosurgeons with the Children¡¯s Cancer hospital and Brain and Spine center are among the most skilled and recognized in the world. They perform more surgeries on brain tumor patients than any hospital in the nation using the least-invasive and most-advanced techniques
Chemotherapy for medulloblastoma
After surgery, most children receive chemotherapy to destroy any remaining cancer cells. Children¡¯s Cancer Hospital offers the most up-to-date and advanced chemotherapy options for pediatric brain tumors.
Some adults with medulloblastoma may receive chemotherapy in addition to radiotherapy to destroy any remaining cancer cells after surgery. This is an important decision, and it is critical to balance factors such as age, the amount of tumor left after surgery, and whether the cancer has spread to other parts of the nervous system or the body.
Radiation therapy for medulloblastoma
Radiation therapy (also called radiotherapy) uses high-energy beams to destroy cancer cells.
All adults with medulloblastoma receive radiation therapy to the brain and the spine (¡°craniospinal radiation¡±) after surgery to stop or slow the growth of any residual tumor that cannot be removed surgically and any tumor cells that may have spread into the cerebrospinal fluid.
Depending on their age and condition, some children receive radiation therapy, as well.
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target brain tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
MD Anderson uses the most advanced radiation treatment methods, including:
- Proton therapy, which delivers high radiation doses directly to the brain tumor site, minimizing damage to nearby healthy tissue. The Proton Therapy Center at MD Anderson is one of the largest and most advanced centers in the world. It¡¯s the only proton therapy facility in the country located within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is known. which can lessen exiting radiation dose to certain organs. Learn more about proton therapy and how it is used to treat medulloblastoma.
- Focused conformal radiation therapy, which is aimed directly at the tumor and the surrounding area.
- Intensity-modulated radiotherapy (IMRT), which shapes the radiation beam to the brain tumor and lessens exposure to the rest of the brain or organs
Targeted therapies for medulloblastoma
Targeted therapies are specially designed to treat each cancer¡¯s specific genetic/molecular profile to help the body fight the disease. Many of the doctors who treat brain tumors at Children¡¯s Cancer Hospital and the Brain and Spine Center are dedicated researchers who have pioneered and actively lead national and international clinical trials to treat brain tumors, including medulloblastoma, with novel targeted agents.
Our experts are collaborating with experts from around the world to better understand the biology and molecular subtypes of medulloblastoma, including relapsed tumors, to design personalized therapies.
Learn more about medulloblastoma:
Learn more about clinical trials for medulloblastoma.
Medulloblastoma is treated at our Children's Cancer Hospital and our Proton Therapy Center
¡®How I knew I had a brain tumor¡¯: 4 survivors share their symptoms
Headaches and seizures are common brain tumor symptoms. But they can also be caused by other medical conditions.
So, how can you tell when a symptom is due to a brain tumor? And when should you see a doctor?
For more insight, we spoke with neuro-oncologist , and four survivors, who shared their first brain tumor symptoms and what led them to see a doctor.
Headache
Shelby Espinosa had had headaches in the past; doctors said they were related to back pain. But at age 22, she got a headache so severe that it caused her to stop mid-conversation.
¡°I had to stop talking and just hold my head,¡± she recalls. ¡°It was so intense that I couldn¡¯t think or respond. The pain would come and go, but the headache lingered for three days.¡±
Her back pain was gone, so she knew this was different. At the urging of her mom and then-fianc¨¦, Shelby went to the emergency room, where she had a CT scan of her brain. Results revealed a tumor the size of a kiwi pressing against her brainstem. She had surgery to remove it, and a biopsy confirmed it was a type of brain tumor called medulloblastoma.
¡°Headaches that may indicate a brain tumor typically feel distinctly different from headaches you¡¯ve had before,¡± says Weathers. ¡°For example, people with chronic migraines are used to having headaches, but their headache usually feels the same each time.¡±
See a doctor if you have a history of headaches and suddenly have a new type of headache. Warning signs could be a headache that:
- wakes you up from sleep
- is worse in the morning
- feels worse when you¡¯re lying flat
- causes nausea and vomiting that won¡¯t go away
¡°Other potentially concerning signs could be a headache that lingers for days or weeks (especially if you rarely get headaches), or a headache that is accompanied by other symptoms, such as weakness, numbness, tingling or vision changes,¡± adds Weathers.
This was the case for Sean O¡¯Brien. He was diagnosed with a brain tumor called juvenile pilocytic astrocytoma at age 20. He¡¯d been suffering from a headache for years but didn¡¯t find it too concerning because his family has a history of migraines and allergies. That was until the headache worsened during his sophomore year of college.
¡°At one point, the headache got so bad I sought out medical services on campus,¡± recalls Sean. ¡°They told me I was overtired and needed to rest. Eventually, I did start to feel a little better.¡±
But then more symptoms arose.
He couldn¡¯t sleep at night. And he began having blind spells where his vision would suddenly go out and return after a few moments. This started happening multiple times a day.
¡°I finally told my parents what was going on, and they got me to a doctor while I was home on Thanksgiving break,¡± says Sean. ¡°The doctor discovered fluid buildup in my brain, and scans revealed a brain tumor.¡±
Seizure
Colin Clarke was playing soccer when he felt numbness on the left side of his face under his eye. Moments later, it happened again. Then he passed out.
¡°The next thing I know, I was on a gurney and put in an ambulance,¡± says Colin, who was 45 at the time. ¡°I didn¡¯t realize I¡¯d had a seizure. I¡¯d just headed the soccer ball! But I was told I had several seizures in the ambulance.¡±
He was later diagnosed with a grade II oligodendroglioma.
¡°A seizure is your body¡¯s way of telling you something is going on medically. Sometimes it could be the hallmark of a new brain tumor that has yet to be discovered,¡± says Weathers. ¡°But it doesn¡¯t always mean a brain tumor. Any of us can seize under certain circumstances; for example, if your sodium drops low enough. Every person¡¯s threshold to have a seizure is different.¡±
On two separate occasions, 39-year-old Chris Cook experienced a metallic taste in his mouth. It was subtle and sudden, and he assumed it was due to old cavities. Two weeks later, he noticed the metallic taste again while running with his dog. He began to feel faint. Then he blacked out.
¡°I woke up to my dog protecting me, first responders and the good Samaritans who called them to help me,¡± Chris recalls. ¡°It was hard for me to comprehend what was happening, and I could not speak coherently. After a few minutes, I could think clearly, but I was unable to verbally express my thoughts until I was loaded into the ambulance.¡±
A neurologist diagnosed him with glioblastoma, the most aggressive type of brain tumor.
¡°A lot of patients think seizures are when your body stiffens all over, and you¡¯re jerking on the ground losing consciousness because that¡¯s what they show on TV,¡± says Weathers. ¡°But seizures come in different types. It could be a flash of colored lights, stiffening and/or jerking of the face, arm and/or leg, or a period where you¡¯re suddenly confused or unable to speak. It can also be an abnormal and typically foul smell or taste. Seizures usually present the same way each time.¡±
If it¡¯s your first time having a seizure, see a doctor.
¡°It may not mean you have a brain tumor, but it could be indicating something else is going on in your body,¡± says Weathers. ¡°The seizure is a warning sign to seek medical attention.¡±
Symptoms vary depending on the brain tumor's location
The type of symptom and its severity depend on where the tumor is in the brain.
Weathers classifies brain tumor symptoms into two buckets: global and focal. A global symptom is a more general symptom indicating something is growing in the brain and causing a buildup of pressure. A focal symptom tells you where the tumor likely is in the brain.
¡°If you have a constant headache for weeks that makes you nauseous or vomit, that¡¯s a global symptom,¡± explains Weathers. ¡°If you have anything growing in your brain, it will give you a headache if it grows large enough and starts pushing. But that doesn¡¯t tell me exactly where it might be.¡±
Sometimes a brain tumor can cause a certain symptom based on where it¡¯s growing in the brain. Depending on the location, you may have:
- difficulty speaking or understanding
- changes in vision, like a visual field cut or double vision
- weakness in the face, arm and/or leg
- numbness or tingling in the face, arm and/or leg
- hearing loss
- trouble swallowing
- slurred speech
Data suggests some symptoms are more common with certain types of brain tumors.
¡°It¡¯s not a perfect correlation, but we tend to see seizures more often in patients with oligodendrogliomas than in patients with astrocytomas,¡± says Weathers.
Bottom line: See a doctor for new or different brain tumor symptoms
Brain tumor symptoms can be subtle, like a vision change. Or they can be more urgent, like a first-time seizure.
¡°Whether you visit an emergency room or make an appointment with your primary doctor may depend on the severity of your symptoms and how sick you feel,¡± notes Weathers. ¡°If you have a new or different symptom that is concerning you or a family member, err on the side of caution. Brain tumor symptoms can mimic those of other medical conditions, so it¡¯s important to see a doctor to get checked out.¡±
or call 1-877-632-6789.
Bride-to-be faces medulloblastoma treatment
Cindy Stueber was supposed to be helping her daughter, Shelby, look at wedding dresses and elegant up-dos. Instead, she was making plans to help Shelby cut her hair, which, once long and thick, was now thinning and sparse from medulloblastoma treatment.
There would be time for those up-dos later, Cindy reminded herself. Shelby¡¯s brain tumor had been removed after her medulloblastoma diagnosis a month earlier, and the brain tumor treatment she was undergoing at MD Anderson would ensure that the cancer didn¡¯t return.
Cindy, a licensed cosmetologist, didn¡¯t want to cut Shelby¡¯s hair, but she wasn¡¯t going to let anyone else do it either.
¡°She¡¯s 23, but she¡¯s still my baby,¡± Cindy says.
With Shelby¡¯s dad, Jeff, and fianc¨¦, David Espinosa, nearby, Cindy began to cut Shelby¡¯s long brown hair. When all the hair was on the ground and Shelby¡¯s head was shaved, both women looked in the mirror and smiled.
A daughter¡¯s medulloblastoma diagnosis
In early March, Shelby had called Cindy and complained of a seemingly never-ending headache.
¡°Mom, it just won¡¯t stop,¡± she told her.
It was so unusual for Shelby that Cindy urged her daughter to go to the emergency room. The two live about an hour from each other in central Texas.
A few hours later Cindy got a call from David. He said she needed to come soon. Cindy and Jeff quickly packed and jumped in the car. When they arrived in College Station, Texas, David and Shelby were home from the hospital and shared what they had learned: Shelby had a mass the size of a kiwi near the back of her head.
A pathology report would later show that it was medulloblastoma, a type of brain tumor common in adolescents. It was unusual in someone Shelby¡¯s age, but not impossible.
It was hard to grasp the news. Just a little over a week before, they had celebrated one of the happiest days of their lives. David had proposed to Shelby near her parents¡¯ home, then threw a surprise engagement party with all of their friends. Well, David thought it was a surprise, at least. Shelby had figured it out, but played along to avoid hurting his feelings.
The family was supposed to be thinking about wedding dresses, venues, cakes and toasts, not scheduling surgeries and chemotherapy.
Seeking brain tumor treatment at MD Anderson
After a surgery in Bryan -- just outside of College Station -- to remove the tumor, Shelby came to MD Anderson. Because it was unusual to find medulloblastoma in someone Shelby¡¯s age, her hometown doctors told her to seek the best care possible at MD Anderson.?
At MD Anderson, Shelby saw , a radiation oncologist who specializes in pediatric and adult brain tumors. She and the rest of Shelby¡¯s care team determined they would use what¡¯s known as the ¡°Packer protocol.¡± Under this treatment plan, there was no need for additional surgery. Instead, Shelby would have six weeks of daily proton therapy, followed by a three- to four-week break and then six cycles of chemotherapy.
Finding comfort, despite COVID-19 visitor restrictions
To keep patients safe from the novel coronavirus (COVID-19), MD Anderson had begun restricting visitors just a few weeks before Shelby started her treatment, so she has to attend her appointments alone. But Cindy says she finds comfort knowing that MD Anderson¡¯s brain tumor experts are taking great care of Shelby and that she¡¯s staying safe at her appointments.
¡°It hurts so much as a parent, knowing there¡¯s nothing you can do,¡± she says. ¡°It¡¯s all in someone else¡¯s hands, so we had to get to the best place for us, and that was MD Anderson.¡±
Cindy and Jeff also take comfort in knowing that David is always there for her daughter. Cindy and David take turns driving Shelby to her appointments and wait patiently in the car in the parking garage.
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