الفهرس 
Risk adapted treatment for medulloblastoma In children
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Abstract
Medulloblastoma (MB) is one of the most common pediatric brain tumors. One hundred seventy five MB patients below the age of 18 years and less were classified into high risk, standered risk and infantile risk groups were enrolled in prospective study of risk adapted radiotherapy and chemotherapy treatment. They were treated at the radiation oncology department, children{u2019}s cancer hospital Egypt (CCHE), during the period from August 2009 to August 2015. Standard risk patients were randomized after surgery into either: group A: Conformal craniospinal-irradiation (CSI) to 23.4Gray (Gy) and, intensity modulated radiotherapy (IMRT) boost to the whole posterior fossa (PF) up to a dose 55.8Gy. group B: Conformal CSI to 23.4 Gy and IMRT Boost to the tumor bed (TB) dose up to 55.8Gy. The median follow up was 42 monthes, 4 years over all survival (OS) of high risk, standard risk and infantile risk group were 68.5+3.2%,82.1+6% and 67.3+6.9% respectively. Four years progression free survival (PFS) is 66.2+3.3, 79.8+4.3% and 67.3+6.9% respectively. The OS in standered risk group A, was 81.1+6%, and 84.7%+4.5 for group B, (p=0.7). The EFS in group A, is 79.1%+6.3, and 84.1%+4.5 for group B (p=0.5). Post second cycle of cisplatine based maintenance chemotherapy, pure tone audiometry (PTA) showed 81.3% (13/16) grade3/grade 4 (G3/G4) sensory neural hearing loss (SNHL) in group A and (31.5%) 6/19 patients of group B, had SNHL hearing deterioration