Journal of Neuro-Oncology

, Volume 120, Issue 1, pp 125–129 | Cite as

Patterns of care in adult medulloblastoma: results of an international online survey

  • Rasha Cosman
  • Christopher S. B. Brown
  • Kevin C. DeBraganca
  • Mustafa KhasrawEmail author
Clinical Study


The literature on medulloblastoma in adults is generally limited to case reports and retrospective series, and there is no accepted standard of care. The Cooperative Trials Group for Neuro-Oncology (COGNO) sought to determine the range and consistency of clinicians’ approaches to management as a basis for future trials. We aimed to identify current treatment strategies for adult medulloblastoma through an online survey launched at the 2012 Society of Neuro-Oncology meeting and by email invitation. Clinicians who had treated at least one adult patient with medulloblastoma, primitive neuroectodermal tumor (PNET), or pineoblastoma in the preceding year were asked about their most recent patient and invited to discuss their approach to a typical clinical scenario. Between November 2012 and January 2013, 45 clinicians (11 medical oncologists, 8 radiation oncologists, 5 pediatric oncologists, and 21 others) from Australia (24), United States (3), Europe (4) and other countries (14) completed the survey. Responding clinicians had treated 54 cases in the past 12 months. The most common histological type was medulloblastoma (64 %), then PNET (20 %). Most patients were male (68 %), and had high-risk disease (65 %). Complete surgical resection in 56 and 32 % had molecular testing. Radiotherapy was predominantly cranio-spinal (92 %) and given mostly post-resection (80 %). Combination chemotherapy was more common than single-agent chemotherapy. The choice of chemotherapy varied considerably. There is substantial variation in the treatment of adult medulloblastoma, most pronounced in the choice of chemotherapeutic agents, highlighting the need for further collaborative research to guide evidence-based treatment strategies.


Adult medulloblastoma Primitive neuroectodermal tumors (PNET) Neurosurgery Radiotherapy Chemotherapy 



This study was conducted under the auspices of the Cooperative Trials Group for Neuro-Oncology (COGNO), coordinated at the National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney. Special thanks to COGNO staff for coordinating the survey. This study was partly funded by the ‘Support for Cancer Clinical Trials 2013-2016’ Cancer Australia grant to the Cooperative Trials Group for Neuro-oncology (COGNO).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Louis DN, Ohgaki H, Wiestler OD et al (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Gandhi R, Babu R, Cummings TJ, Adamson C (2013) Adult primitive neuroectodermal tumors: the prognostic value of supratentorial location. J Neuro-Oncol 114(1):141–148CrossRefGoogle Scholar
  3. 3.
    Polkinghorn WR, Tarbell NJ (2007) Medulloblastoma: tumorigenesis, current clinical paradigm, and efforts to improve risk stratification. Nat Clin Pract Oncol 4(5):295–304PubMedCrossRefGoogle Scholar
  4. 4.
    Korshunov A, Remke M, Werft W et al (2010) Adult and pediatric medulloblastomas are genetically distinct and require different algorithms for molecular risk stratification. J Clin Oncol 28(18):3054–3060PubMedCrossRefGoogle Scholar
  5. 5.
    Parkin D, Whelan S, Ferlay J, Teppo L, Thomas D (2002) Cancer incidence in five continents. Vol. VIII. IARC Scient. Publ Lyon: International Agency for Research on Cancer, Lyon, p 155Google Scholar
  6. 6.
    Wong SF, Mak G, Rosenthal MA, Cher L, Gan HK (2013) Local perspective on a rare brain tumour: adult medulloblastoma. Intern Med J 43(5):567–572PubMedCrossRefGoogle Scholar
  7. 7.
    Lai R (2008) Survival of patients with adult medulloblastoma: a population-based study. Cancer 112(7):1568–1574PubMedCrossRefGoogle Scholar
  8. 8.
    Ang C, Hauerstock D, Guiot MÄ et al (2008) Characteristics and outcomes of medulloblastoma in adults. Ped Blood Cancer 51(5):603–607CrossRefGoogle Scholar
  9. 9.
    Remke M, Hielscher T, Northcott PA et al (2011) Adult medulloblastoma comprises three major molecular variants. J Clin Oncol 29(19):2717–2723PubMedCrossRefGoogle Scholar
  10. 10.
    Pfister S, Remke M, Benner A et al (2009) Outcome prediction in pediatric medulloblastoma based on DNA copy-number aberrations of chromosomes 6q and 17q and the MYC and MYCN loci. J Clin Oncol 27(10):1627–1636PubMedCrossRefGoogle Scholar
  11. 11.
    Chan AW, Tarbell NJ, Black PM et al (2000) Adult medulloblastoma: prognostic factors and patterns of relapse. Neurosurgery 47(3):623–631PubMedGoogle Scholar
  12. 12.
    Silvani A, Gaviani P, Lamperti E et al (2012) Adult medulloblastoma: multiagent chemotherapy with cisplatinum and etoposide: a single institutional experience. J Neuro-Oncol 106(3):595–600CrossRefGoogle Scholar
  13. 13.
    Brandes A, Franceschi E, Tosoni A et al (2009) Adult neuroectodermal tumors of posterior fossa (medulloblastoma) and of supratentorial sites (stPNET). Crit Rev Oncol Hematol 71(2):165–179PubMedCrossRefGoogle Scholar
  14. 14.
    Brandes A, Franceschi E, Tosoni A et al (2007) Long-term results of a prospective study on the treatment of medulloblastoma in adults. Cancer 110(9):2035–2041PubMedCrossRefGoogle Scholar
  15. 15.
    Call JA, Naik M, Rodriguez FJ et al (2014) Long-term outcomes and role of chemotherapy in adults with newly diagnosed medulloblastoma. Am J Clin Oncol 37(1):1–7PubMedCrossRefGoogle Scholar
  16. 16.
    Friedrich C, von Bueren AO, von Hoff K et al (2013) Treatment of adult nonmetastatic medulloblastoma patients according to the paediatric HIT 2000 protocol: a prospective observational multicentre study. Eur J Cancer 49(4):893–903PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Rasha Cosman
    • 1
    • 2
  • Christopher S. B. Brown
    • 1
    • 2
  • Kevin C. DeBraganca
    • 3
  • Mustafa Khasraw
    • 1
    • 2
    • 4
    Email author
  1. 1.Cooperative Trials Group for Neuro-Oncology (COGNO)SydneyAustralia
  2. 2.National Health and Medical Research Council Clinical Trials CentreUniversity of SydneySydneyAustralia
  3. 3.Memorial Sloan-Kettering Cancer CentreNew YorkUSA
  4. 4.Royal Melbourne and Geelong HospitalsDeakin UniversityMelbourneAustralia

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