OnCo

Medulloblastoma: lines of therapy

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4 standard-of-care settings across 4 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersAge groupRisk group
Advanced, first line··1
Second line1··
Third line and beyond1··
Other settings·1·

Advanced, first line

SubgroupSettingApproachProducts and trialsEvidence
Risk groupHigh risk (metastatic, residual, anaplastic, MYC)CSI 36 Gy ± concurrent carboplatin (ACNS0332 for Group 3), then multi-agent chemotherapy; high-dose chemotherapy with stem-cell rescue in some protocols.81

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersRelapsedRe-irradiation, temozolomide-irinotecan ± bevacizumab, SMO inhibitor (vismodegib/sonidegib) for SHH in post-pubertal patients, clinical trials; cure is rare.98

Third line and beyond

SubgroupSettingApproachProducts and trialsEvidence
All comersAverage risk (≥3 years, M0, <1.5 cm² residual, no MYC amp)Resection, CSI 23.4 Gy with boost to 54 Gy (proton where available), then cisplatin/vincristine/cyclophosphamide or lomustine-based chemotherapy (ACNS0331); WNT tumours receive reduced CSI in trials.91

Other settings

SubgroupSettingApproachProducts and trialsEvidence
Age groupInfants (<3 years)Radiation-avoiding intensive chemotherapy (Head Start, HIT-SKK with intraventricular methotrexate); desmoplastic/SHH infants do well, Group 3 infants poorly.68

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.