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Radiology · Radiotherapy: craniospinal irradiation
Sample itemA child after resection of a posterior fossa medulloblastoma is to receive postoperative radiotherapy. Why is the whole neuraxis included in the fields?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. The tumour spreads through CSF and can seed the spinal canal
Medulloblastoma tends to disseminate along the CSF pathways, producing drop metastases in the spine. Craniospinal irradiation treats the entire subarachnoid space, with a boost to the posterior fossa. Late effects in survivors, such as growth and cognitive problems, are significant.
Option by option
A. The cord is radioresistant
The cord is not particularly radioresistant.
B. The brainstem requires prophylactic irradiation
The brainstem is not treated prophylactically for this reason.
C. Medulloblastoma metastasises to bone only
Bone is not the usual metastatic site.
D. The tumour spreads through CSF and can seed the spinal canal (correct)
Correct. CSF seeding explains neuraxis treatment.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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