**18. Conclusion**

Irinotecan in a study with short follow-up has shown to have good prospect with a DCR of 73% [89]. Trials with multiagent oral antiangiogenic regimen like Bevacizumab, Cilengitide, Lenalidomide and Thalidomide either in monotherapy or in combination with Vincristine, Irinotecan, Temozolomide or Temsirolimus in patients with medulloblastoma yielded only

Tyrosine kinase inhibitors (TKIs) like imatinib, sorafenib, lapatinib, nilotinib, dasatinib, ponatinib and bafetinib have shown to block the migration and invasion properties of MB cells which may prove to be effective alternative agents in the treatment of medulloblastomas [128]. In order to reduce treatment related side effects, newer radiotherapy techniques are being evaluated. IMRT and helical tomotherapy have been evaluated, but results were not very

Immunotherapy is another novel therapeutic approach that is being evaluated for the treatment of medulloblastoma. The target antigens that have been identified are cancer testis antigens (CTAs), MAGE and GAGE proteins. MAGE-4, MAGE-A and GAGE expression have been found in 50, 62 and 84% of medulloblastomas respectively [138, 139]. MAGE antigens, are a promising targets for immunotherapy in patients with medulloblastoma as it has paved the way of immunotherapy already by targeting successfully in some other tumors [140, 141]. Vaccinations against EGFRvIII in combination with GM-CSF, is another potential immuno-

In the post-surgery treatment process, delivery of anticancer drugs across the BBB remains a challenge. A number of methods have been tried to facilitate effective drug delivery across the BBB to the brain. Of those, a very promising technique is Nanoparticles (NP) encapsulating magnetic materials such as iron oxide. Upon entering the systemic circulation, through NPs a drug can be directed remotely to the disease site. The addition of receptor-specific ligands to

Quality of life and psychosocial outcomes following treatment of medulloblastoma are progressively recognized as crucial issues in decision-making regarding therapy. Long-term outcome was less emphasized than survival previously as survival was nominal in the earlier period of history of medulloblastoma, though the thought of prolongation of life and making it worth living was always there with the encouragement to persist in efforts [2]. Over the past decades, survival has improved significantly, and expectantly will continue to improve with the development of molecularly targeted agents and other modalities of treatment. With time, thoughts regarding quality of life is becoming increasingly vital both in decisionmaking concerning therapy and in the design of future treatment protocols where quality of life is the prime target next to survival [6]. Treatment-related endocrinologic, cognitive, and psychological sequelae, especially in Infants and very young children with medulloblastoma remain a difficult therapeutic challenge which can be tackled prudently with rehabilitation programs. For that it is an obvious need to develop active rehabilitative programs and special

therapeutic approach, which have already been tested in other brain tumors [142].

magnetic NPs for active targeting can significantly increase their efficacy [128].

short-lasting disease stabilizations with a tolerable toxicity profile [132–137].

pleasing [24].

156 Brain Tumors - An Update

**17. Rehabilitation**

Medulloblastomas have been neurosurgeons' nightmare for years. MB, a highly aggressive tumor of the cerebellum, treated with a combination of surgery, craniospinal irradiation and chemotherapy, still remains a challenge. Enriched knowledge of histological and molecular subgroups with their aberrant signaling pathways has provided novel therapeutic targets for MB to regress their growth and has enhanced both the prognostic and therapeutic implications. Efforts to modify and refine the MB treatment strategy are ongoing as toxicity and off-target effects of various newer drugs are yet not under total control. Regardless of marked advancements in overall survival for medulloblastoma patients over the past decades, substantial successes remain to be achieved, especially concerning improvement in survival, mitigating treatment-related morbidities as well as improving quality of life for survivors. These have led to modifications of therapies and research, with the emphasis on novel, less toxic and more targeted agents for the best possible survival with least long-term adverse consequences for a worthwhile post-therapy quality of life. The combination of molecular pharmacology, neurogenetics, cell biology, and biophysics will ultimately drive the utmost hope of a cure for medulloblastoma. With the advancement of modern research, medulloblastoma, once a dreaded and hopeless entity, is looming to be a potentially curable disease.
