title: The use of stereotactic radiosurgical boost in the treatment of medulloblastomas.
abstract: OBJECTIVE
  Starting in 1992, we began using a stereotactic radiosurgical (SRS) boost for the treatment of medulloblastomas. Four patients ranging in age from 7 to 42 years old have since been treated and are the subject of this retrospective study.
  
  
  METHODS
  All patients were initially treated with a maximally debulking surgery and external beam radiotherapy, which were then followed by a stereotactic radiosurgical boost using a modified 6 MeV linear accelerator. Radiosurgical boost doses ranged from 4.50 to 10.0 Gy. Target volumes ranged from 1.1 to 8.1 cc. The procedure was well tolerated with minimal acute toxicities.
  
  
  RESULTS
  All four patients are alive without evidence of recurrence (at 8 to 35 months). Acute nausea and vomiting was elicited during the radiosurgical procedure in the first patient treated. We have since begun premedicating patients with antiemetics or treating under general anesthesia. Late complications consisted of panhypopituitarism in one patient, which was thought to be attributable to the previous course of whole-brain radiotherapy. We have not observed any incidence of radionecrosis in this small cohort of patients.
  
  
  CONCLUSIONS
  Our preliminary results with the use of radiosurgery for medulloblastomas are optimistic, and we would like to suggest the inclusion of a radiosurgery boost in future clinical trials for treatment of this disease.
authors.affiliation: Department of Radiation Oncology, The University of Arizona Health Sciences Center, Tucson 85724, USA.
authors.forename: C
authors.initials: C
authors.lastname: Woo
authors.forename: B
authors.initials: B
authors.lastname: Stea
authors.forename: B
authors.initials: B
authors.lastname: Lulu
authors.forename: A
authors.initials: A
authors.lastname: Hamilton
authors.forename: J R
authors.initials: JR
authors.lastname: Cassady
mesh_terms: D000328:Adult; D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000000981:diagnostic imaging / Q000601:surgery*; D016634:Radiosurgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed