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Treatment and prognosis of medulloblastoma

Scott L Pomeroy, MD, PhD
Section Editors
Jay S Loeffler, MD
Patrick Y Wen, MD
Amar Gajjar, MD
Deputy Editor
April F Eichler, MD, MPH


Medulloblastoma is the most common malignant brain tumor of childhood and occurs exclusively in the cerebellum. Treatment consists of a combined modality approach that includes surgery, radiation therapy and chemotherapy in most patients. Long-term survival is now achieved in approximately three-quarters of patients, but each component of therapy can cause delayed complications that have a profound effect on quality of life in survivors. Clinical trials and future research efforts are focused on attempts to decrease treatment toxicity while maintaining high cure rates in patients with medulloblastoma.

The treatment and prognosis of medulloblastoma in children and adults, as well as the delayed complications of therapy, are discussed here. The clinical presentation, diagnosis, risk stratification, histopathology, and molecular pathogenesis of medulloblastoma are discussed separately. (See "Clinical presentation, diagnosis, and risk stratification of medulloblastoma" and "Histopathology and molecular pathogenesis of medulloblastoma".)


The optimal initial treatment of patients with medulloblastoma includes both general measures to alleviate increased intracranial pressure and specific therapy directed against the tumor. Based upon results from multiple cooperative group trials, preferred approach includes a combination of maximal safe surgical resection, radiation therapy (RT) to both the tumor site and the craniospinal axis, and systemic chemotherapy. The application of this combined modality approach to different risk groups is discussed below. (See 'Initial therapy' below.)

Increased intracranial pressure — Patients with medulloblastoma often present with increased intracranial pressure due to obstructive hydrocephalus from compression of the fourth ventricle by the expanding tumor. Placement of a cerebrospinal fluid (CSF) shunt to relieve hydrocephalus is usually deferred until surgical resection, since surgery alone is often sufficient to treat this problem.

Local swelling from the tumor can contribute to symptoms of increased intracranial pressure. This vasogenic tumor edema is typically relieved by treatment with corticosteroids. The management of increased intracranial pressure is discussed separately. (See "Elevated intracranial pressure (ICP) in children" and "Evaluation and management of elevated intracranial pressure in adults".)


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Literature review current through: Sep 2016. | This topic last updated: Aug 24, 2016.
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