Medulloblastoma of brain
ICD-10 C71.9 · ICD-11 2A00.10

Treatment of Medulloblastoma After Surgery When Residual Tumour Exceeds 1.5 cm² or Metastatic Stage Is Greater Than M1

This protocol addresses medulloblastoma of the brain in patients classified as high risk based on post-surgical tumour burden, extent of metastatic spread, or specific histological and molecular features.

High-Risk Criteria — This Scenario Applies When:
  • Residual tumour volume greater than 1.5 cm² on postoperative imaging
  • Metastatic stage greater than M1
  • Large cell or anaplastic medulloblastoma histology
  • Group 4 molecular subgroup
  • SHH-activated, TP53-mutant medulloblastoma
Primary Treatment Goal Achieve residual tumour volume below 1.5 cm² on postoperative MRI performed within 48 hours of surgery.
Approach Overview (Partial) Management in this high-risk setting involves surgical resection — including pre-operative measures to address raised intracranial pressure — followed by mandatory craniospinal irradiation and the addition of systemic chemotherapy. Full sequencing, fractionation strategy, and chemotherapy regimen details are in the structured protocol →
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/S1470-2045(19)30669-2

High risk • Residual tumour >1·5 cm² • >M1 • Large cell/anaplastic histology • Group 4 molecular subgroup • SHH TP53mut

Vasogenic tumour oedema should be reduced by administration of corticosteroids before surgery (level III A).

If possible, surgery with definite tumour removal should be used to relieve the obstruction-causing hydrocephalus (level III A).

A gross total resection (GTR) with a residual volume of less than 1·5 cm² should be done in all patients to alleviate symptoms and to facilitate rapid diagnosis (level II A).

In cases where GTR is either not safe or not feasible, a maximal safe resection sparing eloquent areas and leaving residual tumour behind should be done (level II A).

Craniospinal irradiation is mandatory (level I A).

Adult patients with medulloblastoma should be treated with systemic therapy, in addition to resection and radiotherapy, irrespective of their risk category (level II A).

A postoperative MRI should be done within 48 h (level III A).

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