Indian Society of Neuro-Oncology consensus guidelines for the contemporary management of medulloblastoma

Gupta, Tejpal; Sarkar, Chitra; Rajshekhar, Vedantam; Chatterjee, Sandip; Shirsat, Neelam; Muzumdar, Dattatraya; Pungavkar, Sona; Chinnaswamy, Girish; Jalali, Rakesh

doi:10.4103/0028-3886.201841

Cited by 30 publications

(20 citation statements)

References 4 publications

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“…In patients with suspected brain tumors, a computed tomography (CT) scan and/or magnetic resonance imaging (MRI) of the brain is required to arrive at a presumptive diagnosis and guide further decisionmaking. Given the high propensity of neuraxial spread in medulloblastoma via cerebrospinal fluid pathways, pre-operative imaging of the spine is also recommended in the initial diagnostic work-up of children with posterior fossa tumors [16,17] . The features of medulloblastoma on conventional neuro-imaging have been very well characterized and described in the indexed medical literature [16,17] .…”

Section: Conventional Imaging Features Of Medulloblastomamentioning

confidence: 99%

“…Given the high propensity of neuraxial spread in medulloblastoma via cerebrospinal fluid pathways, pre-operative imaging of the spine is also recommended in the initial diagnostic work-up of children with posterior fossa tumors [16,17] . The features of medulloblastoma on conventional neuro-imaging have been very well characterized and described in the indexed medical literature [16,17] . Medulloblastoma is generally seen as a well-defined, solid, hyper-dense lesion on plain CT that shows variable enhancement post-contrast, it arises typically from the vermis in the midline posterior fossa and fills the fourth ventricle causing obstructive hydrocephalus; less commonly it is located laterally in the cerebellar hemisphere with or without extension to the foramen.…”

Section: Conventional Imaging Features Of Medulloblastomamentioning

confidence: 99%

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Radiogenomics of medulloblastoma: imaging surrogates of molecular biology

Dasgupta¹,

Gupta²

2018

JTGG

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Medulloblastoma is a heterogeneous disease comprising four molecular subgroups-wingless (WNT), sonic hedge hog (SHH), group 3, and group 4, with distinct developmental origins, unique transcriptional profiles, diverse phenotypes, and varying clinical outcomes. Magnetic resonance imaging (MRI) is the preferred first-line imaging modality in the diagnosis and staging of suspected brain tumors including medulloblastoma. It is being increasingly recognized that imaging features reflect underlying disease biology that can serve as independent predictive and prognostic biomarkers. Radiogenomics is an emerging field of research that aims to define relationships between non-invasive imaging features (radio-phenotypes) and genomic data/molecular markers (molecular phenotypes). Recent studies have reported encouraging data regarding imaging genomics of medulloblastoma with certain MRI features correlating with specific molecular subgroups. These include lateralized cerebellar location for SHH-subgroup; cerebellopontine angle location for WNT-subgroup; and inferior location with dilation of superior recess of the IVth ventricle for group 4 tumors. Minimal enhancement of primary tumor and ependymal metastases (infundibular/suprasellar) with mismatching pattern is a specific feature of group 4 medulloblastoma. A 5-metabolite signature profile on magnetic resonance spectroscopy reliably differentiates SHH-subgroup from non-WNT/non-SHH medulloblastoma. SHH-specific binary nomogram (location on horizontal and vertical axis, relationship with dorsal brainstem, pattern of contrast-enhancement, and peri-tumoral edema as discriminating imaging features) is associated with excellent predictive accuracy, followed by group 4-specific nomogram, with suboptimal accuracy of WNT and group 3-specific nomograms. The advent of deep machine-learning techniques and convoluted artificial neural networks should provide unique opportunities to further improve the accuracy of such radiogenomic correlation and prediction.

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Section: Conventional Imaging Features Of Medulloblastomamentioning

confidence: 99%

Section: Conventional Imaging Features Of Medulloblastomamentioning

confidence: 99%

Radiogenomics of medulloblastoma: imaging surrogates of molecular biology

Dasgupta¹,

Gupta²

2018

JTGG

Self Cite

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“…However, the prognosis is thought to be depend mainly on the histological type and the molecular subtype. In the ISNO guidelines on the “Consensus risk stratification in the molecular era of medulloblastoma,” the risk category for medulloblastoma with myogenic differentiation remains unknown 12 …”

Section: Discussionmentioning

confidence: 99%

Squash cytology of a case of medulloblastoma with myogenic differentiation

Bhattacharya

Bansal

et al. 2020

Diagnostic Cytopathology

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Medulloblastoma with myogenic differentiation is not a distinct entity but a pattern of differentiation seen in <1% of medulloblastomas. Although squash cytology of medulloblastoma is well described, there are no reports available describing squash cytomorphology of this unusual variant of medulloblastoma. Intraoperative squash smears on a 2-year-old girl with a midline posterior fossa space occupying lesion revealed features of an embryonal tumor composed of small, round, and blue cells. In addition, it had several large, round, eosinophilic rhabomyoblasts, and a few strap cells scattered among the sea of small blue cells. Subsequent histology showed features of a medulloblastoma, classic type with myogenic differentiation. Molecular subtyping, based on immunohistochemistry alone, was in keeping with a non-Wnt/ non-SHH activated type. Here we describe the squash cytomorphological details of a case of medulloblastoma with myogenic differentiation, along with its cytological differentials.

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“…CT scan of the patient from the skull vertex to coccyx in supine position using immobilization device on Somatom Scope 32 slice multislice CT scanner (Siemens Shenghai Medical Equipment Limited, China) was done with 3-mm slice thickness. CT images were analyzed for contouring on SomaVision workstation (Varian Medical Systems, Inc., Palo Alto, CA, USA) where the target volumes (PTV Brain, PTV Spine) and normal structures were delineated by radiation oncologist as per the recommended guidelines of ICRU62 and Children's Oncology Group [10][11][12].…”

Section: Patient Characteristics and Ct Simulationmentioning

confidence: 99%

Evaluation of Dosimetric Parameters for Adolescent Craniospinal Irradiation

Verma¹,

Jain²,

Chougule³

2020

IJAR

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Background: Craniospinal irradiation (CSI) is an important and challenging radiotherapy technique used for the treatment of Medulloblastoma, one of the most common pediatric cancers. Pediatric patients present with wide variability in weight, height, spine length, brain diameter, body size, intra and inter fractional motion depending on their age as compared to adults. These parameters have significant impact on radiation dose delivery to target and normal structures during radiotherapy of pediatric cancer patients. The present study was aimed to evaluate dosimetric parameters and generate plan quality indices for adolescent CSI. Materials and Methods: A 17 years old male adolescent patient with Medulloblastoma was recruited in the present sturdy. The patient was planned with RapidArc TM / Volumetric Modulated Arc Therapy (VMAT) mode using 6 MV X-Ray photon beam from Varian Trilogy with FFF machine. The dose points such as max, mean, 2%, 98%, 95%, 105% and 107% were collected using dose statistics and dose volume histogram (DVH) and analyzed for calculation of various dosimetric parameters. The in-vivo dosimetry was performed and radiation doses to eyes were assessed using CaSO4:Dy TLD powder. Results: The plans were approved with a gamma passing rate (3%, 3mm) of more than 95%. The dose homogeneity index and conformity index were observed 0.074 and 1.10 respectively. The average doses to eyes were observed approximately 35% of the tumor dose during RapidArc TM-CSI. The results of the present study demonstrated that V5 was observed high the normal structures except kidneys. Esophagus and thyroid were receiving significant low dose spillage at a cost of high homogeneity and conformity of dose to PTV which were needed to enhance tumor control probability (TCP) of Medulloblastoma. Conclusion: The present study developed a benchmark guide for adolescent RapidArc TM-CSI.

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Indian Society of Neuro-Oncology consensus guidelines for the contemporary management of medulloblastoma

Cited by 30 publications

References 4 publications

Radiogenomics of medulloblastoma: imaging surrogates of molecular biology

Radiogenomics of medulloblastoma: imaging surrogates of molecular biology

Squash cytology of a case of medulloblastoma with myogenic differentiation

Evaluation of Dosimetric Parameters for Adolescent Craniospinal Irradiation

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