Treatment of Medulloblastoma of Brain with Residual Tumour <1.5 cm² After Surgery at Metastatic Stage M0 or M1
Clinical Scenario
This protocol applies to intermediate-risk medulloblastoma where postoperative residual tumour volume is less than 1.5 cm², metastatic staging is M0 or M1, and histology is classified as classic or desmoplastic. Molecular subgroup is WNT or SHH.
Residual <1.5 cm²
Stage M0 / M1
Classic or Desmoplastic
WNT or SHH subgroup
Intermediate risk
Treatment Approach
Management involves surgical resection targeting a residual volume below 1.5 cm² — confirmed on postoperative MRI within 48 hours — followed by mandatory craniospinal irradiation and a structured systemic chemotherapy regimen added irrespective of risk category.
Complete sequencing, dose details, and specific regimen components are defined in the full protocol.
References
DOI: 10.1016/S1470-2045(19)30669-2
- Intermediate risk • Residual tumour <1·5 cm² • M0, M1 • Classic or desmoplastic histology • WNT or SHH molecular subgroup
- 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).
- Craniospinal irradiation is mandatory (level I A), and due to the large target volume, it is a technically complex approach.
- 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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