Recurrence of medulloblastoma after homogeneous field radiotherapy

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Abstract
Three cases were reported of posterior fossa medulloblastoma in children. In each case metastatic spread occurred despite homogeneous field radiotherapy to the whole neuraxis; the secondary tumor was located in the subfrontal region. In the 2 cases in which operative removal of the metastasis was carried out, the tumor was extracerebral and was attached to the dura in the region of the cribriform plate. The face-down position of patients during operations on the posterior fossa made this area the most dependent part and therefore the most likely recipient of tumor cells shed at operation. This area was not previously included in the field of maximum dosage for radiotherapy, but as a result of these findings a modification in technique of radiotherapy was suggested.