Childhood Medulloblastoma

CNS primitive neuroectodermal tumors (PNETs), including cerebellar PNET (medulloblastoma, MB), are the most common malignant brain tumors in children and constitute 20-25% of all pediatric brain tumors. Because of the high risk of leptomeningeal dissemination, standard postoperative treatment for PNET includes not only local radiotherapy but also craniospinal radiotherapy and chemotherapy. Such treatment causes long-term morbidity, including endocrine and growth disturbances, and neurocognitive dysfunction, which is particularly severe in young children.

Clinical prognostic factors for PNET have been identified over the last two decades. These include meta-static stage, extent of tumor resection, tumor location, and age, and are currently used to distinguish a ''high-risk'' group of patients (M stage > 1, residual tumor bulk > 1.5 cm2, age <3 years, supratentorial tumor location) from a ''standard-risk'' group. However, investigators have appropriately avoided the use of the term ''low risk'' or ''good outcome,'' because published survival rates in the 50-60% range do not justify such terms. At present, clinical prognostic factors cannot identify a good-outcome group of MB patients suitable for treatment with a substantially less toxic treatment strategy than the standard treatment. As it is unlikely that new clinical prognostic factors will be found, biological prognostic factors must be identified to further improve MB prognostic systems.

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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