Skip to main content

Advertisement

SpringerLink
Log in

Management of recurrent medulloblastoma in adult patients: a systematic review and recommendations

  • Topic Review
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Medulloblastoma accounts for almost one-third of pediatric central nervous system (CNS) cancers, but is very rare in the adult population. As a result, adult patients with medulloblastoma are often treated according to therapies developed for children with similarly staged disease at diagnosis, based on the assumption that adult and pediatric tumors have similar properties. The purpose of this review was to summarize the evidence and to make recommendations for the management of recurrent disease in adult patients with medulloblastoma. We conducted a systematic literature search to find publications addressing treatment of recurrent medulloblastoma in adults. Current treatment strategies for adult patients with relapsed medulloblastoma are based on the results of retrospective case series and published consensus recommendations, and include maximal safe re-resection where possible, combined with chemotherapy and/or re-irradiation. We describe the results of 13 publications involving 66 adult patients treated with high-dose chemotherapy (HDCT) plus stem cell transplantation for recurrent medulloblastoma. HDCT with stem cell transplantation may be a treatment option for a small proportion of adult patients who are unlikely to benefit from conventional chemotherapy and who are fit and have their disease recurrence contained within the CNS. Potential cases in which stem cell transplantation is being considered should be discussed at a multidisciplinary tumor board which includes involvement by hematologic oncologists and transplant specialists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Brandes AA, Paris MK (2004) Review of the prognostic factors in medulloblastoma of children and adults. Crit Rev Oncol Hematol 50(2):121–128

    Article  PubMed  Google Scholar 

  2. Bloom HJG, Bessel EM (1990) Medulloblastoma in adults: a review of 47 patients treated between 1952 and 1981. Int J Radiat Oncol Biol Phys 18(4):763–772

    Article  PubMed  CAS  Google Scholar 

  3. Carrie C, Lasset C, Alapetite C, Haie-Meder C, Hoffstetter S, Demaille MC et al (1994) Multivariate analysis of prognostic factors in adult patients with medulloblastoma: retrospective study of 156 patients. Cancer 74(8):2352–2360

    Article  PubMed  CAS  Google Scholar 

  4. Kunschner LJ, Kuttesch J, Hess K, Yung WKA (2001) Survival and recurrence factors in adult medulloblastoma: the MD Anderson Cancer Center experience from 1978 to 1998. Neuro Oncol 3(3):167–173

    PubMed  CAS  Google Scholar 

  5. Brandes AA, Franceschi E, Tosoni A, Blatt V, Ermani M (2007) Long-term results of a prospective study on the treatment of medulloblastoma in adults. Cancer 110(9):2035–2041

    Article  PubMed  Google Scholar 

  6. Remke M, Hielscher T, Northcott PA, Witt H, Ryzhova M, Wittmann A et al (2011) Adult medulloblastoma comprises three major molecular variants. J Clin Oncol 29(19):2717–2723

    Article  PubMed  Google Scholar 

  7. Taylor MD, Northcott PA, Korshunov A, Remke M, Cho YJ, Clifford SC et al (2012) Molecular subgroups of medulloblastoma: the current consensus. Acta Neuropathol 123(4):465–472

    Article  PubMed  CAS  Google Scholar 

  8. Northcott PA, Korshunov A, Witt H, Hielscher T, Eberhart CG, Mack S et al (2011) Medulloblastoma comprises four distinct molecular variants. J Clin Oncol 29(11):1408–1414

    Article  PubMed  Google Scholar 

  9. Kool M, Korshunov A, Remke M, Jones DT, Schlanstein M, Northcott PA et al (2012) Molecular subgroups of medulloblastoma: an international meta-analysis of transcriptome, genetic aberrations, and clinical data of WNT, SHH, Group 3, and Group 4 medulloblastomas. Acta Neuropathol 123(4):473–484

    Article  PubMed  CAS  Google Scholar 

  10. Padovani L, Sunyach MP, Perol D, Mercier C, Alapetite C, Haie-Meder C et al (2007) Common strategy for adult and pediatric medulloblastoma: a multicenter series of 253 adults. Int J Radiat Oncol Biol Phys 68(2):433–440

    Article  PubMed  Google Scholar 

  11. Giordana MT, Cavalla P, Dutto A, Borsotti L, Chiò A, Schiffer D (1997) Is medulloblastoma the same tumor in children and adults? J Neurooncol 35(2):169–176

    Article  PubMed  CAS  Google Scholar 

  12. Roldán G, Brasher P, Vecil G, Senger D, Rewcastle B, Cairncross G et al (2008) Population-based study of medulloblastoma: outcomes in Alberta from 1975 to 1996. Can J Neurol Sci 35(2):210–215

    PubMed  Google Scholar 

  13. Chan AW, Tarbell NJ, Black PM, Louis DN, Frosch MP, Ancukiewicz M et al (2000) Adult medulloblastoma: prognostic factors and patterns of relapse. Neurosurgery 47(3):623–631

    PubMed  CAS  Google Scholar 

  14. Riffaud L, Saikali S, Leray E, Hamlat A, Haegelen C, Vauleon E et al (2009) Survival and prognostic factors in a series of adults with medulloblastomas. J Neurosurg 111(3):478–487

    Article  PubMed  Google Scholar 

  15. Balducci M, Chiesa S, Chieffo D, Manfrida S, Dinapoli N, Fiorentino A et al (2012) The role or radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature. J Neurooncol 106(2):315–323

    Article  PubMed  CAS  Google Scholar 

  16. National Comprehensive Cancer Network (2013) NCCN Clinical Practice Guidelines in Oncology: Central Nervous System Cancers. Version 1.2013. www.nccn.org/professionals/physician_gls/f_guidelines.asp#site Accessed 18 Mar 2013

  17. Alberta Health Services. (2010). Clinical Practice Guidelines, Cancer Care: Medulloblastoma. Developed: August, 2010. www.albertahealthservices.ca/hp/if-hp-cancer-guide-cns008-medulloblastoma.pdf. Accessed 18 Mar 2013

  18. Balter-Seri J, Mor C, Shuper A, Zaizov R, Cohen IJ (1997) Cure of recurrent medulloblastoma: the contribution of surgical resection at relapse. Cancer 79(6):1241–1247

    Article  PubMed  CAS  Google Scholar 

  19. Merchant TE, Pollack IF, Loeffler JS (2010) Brain tumors across the age spectrum: biology, therapy, and late effects. Semin Radiat Oncol 20(1):58–66

    Article  PubMed  Google Scholar 

  20. Friedman H, Mahaley S, Schold C, Vick NA, Falletta JM, Bullard DE et al (1986) Efficacy of vincristine and cyclophosphamide in the therapy of recurrent medulloblastoma. Neurosurgery 18:335–340

    Article  PubMed  CAS  Google Scholar 

  21. Duffner PK, Cohen ME, Thomas PR, Sinks LF, Freeman AI (1979) Combination chemotherapy in recurrent medulloblastoma. Cancer 43:41–45

    Article  PubMed  CAS  Google Scholar 

  22. Nygaard R, Kivivuori SM (2012) Treatment for recurrent medulloblastoma with intrathecal liposomal cytarabine and systemic metronomic combination therapy. Anticancer Drugs 23(3):342–346

    Article  PubMed  CAS  Google Scholar 

  23. Privitera G, Acquaviva G, Ettorre GC, Spatola C (2009) Antiangiogenic therapy in the treatment of recurrent medulloblastoma in the adult: case report and review of the literature. J Oncol. doi:10.1155/2009/247873

    PubMed  Google Scholar 

  24. Durando X, Thivat E, Gilliot O, Irthum B, Varrelle P, Vincent C et al (2007) Temozolomide treatment of an adult with a relapsing medulloblastoma. Cancer Invest 25:470–475

    Article  PubMed  CAS  Google Scholar 

  25. Rudin CM, Hann CL, Laterra J, Yauch RL, Callahan CA, Fu L et al (2009) Treatment of medulloblastoma with hedgehog pathway inhibitor GDC-0449. N Engl J Med 361(12):1173–1178

    Article  PubMed  CAS  Google Scholar 

  26. Levin VA, Vestnys PS, Edwards MS, Wara WM, Fulton D, Barger G et al (1983) Improvement in survival produced by sequential therapies in the treatment of recurrent medulloblastoma. Cancer 51(8):1364–1370

    Article  PubMed  CAS  Google Scholar 

  27. Bauman GS, Sneed PK, Wara WM, Stalpers LJ, Chang SM, McDermott MW et al (1996) Reirradiation of primary CNS tumors. Int J Radiat Oncol Biol Phys 36(2):433–441

    Article  PubMed  CAS  Google Scholar 

  28. Bakst RL, Dunkel IJ, Gilheeney S, Khakoo Y, Becher O, Souweidane MM et al (2011) Reirradiation for recurrent medulloblastoma. Cancer 117(21):4977–4982

    Article  PubMed  Google Scholar 

  29. Houghton F, Healy E, Harney J (2008) Re-irradiation of recurrent medulloblastoma—a case report. Clin Oncol (R Coll Radiol) 20:564–565

    Article  CAS  Google Scholar 

  30. Buglione M, Triggiani L, Grisanti S, Liserre R, Buttolo L, Gipponi S et al (2013) Retreatment of recurrent adult medulloblastoma with radiotherapy: a case report and review of the literature. J Med Case Rep 7(1):64

    Article  PubMed  Google Scholar 

  31. Milker-Zabel S, Zabel A, Thilmann C, Zuna I, Hoess A, Wannenmacher M et al (2002) Results of three-dimensional stereotactically-guided radiotherapy in recurrent medulloblastoma. J Neurooncol 60(3):227–233

    Article  PubMed  Google Scholar 

  32. Marks JE, Baglan RJ, Prassad SC, Blank WF (1981) Cerebral radionecrosis: incidence and risk in relation to dose, time, fractionation and volume. Int J Radiat Oncol Biol Phys 7:243–252

    Article  PubMed  CAS  Google Scholar 

  33. Tokuuye K, Akine Y, Sumi M, Kagami K, Ikeda H, Oyama H et al (1998) Reirradiation of brain and skull base tumors with fractionated stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 40(5):1151–1155

    Article  PubMed  CAS  Google Scholar 

  34. Dunkel IJ, Gardner SL, Garvin JH Jr, Goldman S, Shi W, Finlay JL (2010) High-dose carboplatin, thiotepa, and etoposide with autologous stem cell rescue for patients with previously irradiated recurrent medulloblastoma. Neuro Oncol 12(3):297–303

    Article  PubMed  CAS  Google Scholar 

  35. Zia MI, Forsyth P, Chaudhry A, Russell J, Stewart DA (2002) Possible benefits of high-dose chemotherapy and autologous stem cell transplantation for adults with recurrent medulloblastoma. Bone Marrow Transplant 30(9):565–569

    Article  PubMed  CAS  Google Scholar 

  36. Dunkel IJ, Boyett JM, Yates A, Rosenblum M, Garvin JH Jr, Bostrom BC et al (1998) High-dose carboplatin, thiotepa, and etoposide with autologous stem-cell rescue for patients with recurrent medulloblastoma. Children’s Cancer Group. J Clin Oncol 16(1):222–228

    CAS  Google Scholar 

  37. Park JE, Kang J, Yoo KH, Sung KW, Koo HH, Lim do H et al (2010) Efficacy of high-dose chemotherapy and autologous stem cell transplantation in patients with relapsed medulloblastoma: a report on the Korean Society for Pediatric Neuro-Oncology (KSPNO)-S-053 study. J Korean Med Sci 25(8):1160–1166

    Article  PubMed  CAS  Google Scholar 

  38. Grodman H, Wolfe L, Kretschmar C (2009) Outcome of patients with recurrent medulloblastoma or central nervous system germinoma treated with low dose continuous intravenous etoposide along with dose-intensive chemotherapy followed by autologous hematopoietic stem cell rescue. Pediatr Blood Cancer 53(1):33–36

    Article  PubMed  Google Scholar 

  39. Gill P, Litzow M, Buckner J, Arndt C, Moynihan T, Christianson T et al (2008) High-dose chemotherapy with autologous stem cell transplantation in adults with recurrent embryonal tumors of the central nervous system. Cancer 112(8):1805–1811

    Article  PubMed  CAS  Google Scholar 

  40. Secondino S, Pedrazzoli P, Schiavetto I, Basilico V, Bramerio E, Massimino M et al (2008) Antitumor effect of allogeneic hematopoietic SCT in metastatic medulloblastoma. Bone Marrow Transplant 42(2):131–133

    Article  PubMed  CAS  Google Scholar 

  41. van den Berkmortel F, Gidding C, De Kanter M, Punt CJ (2006) Severe encephalopathy after high-dose chemotherapy with autologous stem cell support for brain tumours. Anticancer Res 26(1B):729–733

    PubMed  Google Scholar 

  42. Abrey LE, Rosenblum MK, Papadopoulos E, Childs BH, Finlay JL (1999) High dose chemotherapy with autologous stem cell rescue in adults with malignant primary brain tumors. J Neurooncol 44(2):147–153

    Article  PubMed  CAS  Google Scholar 

  43. Millot F, Delval O, Giraud C, Bataille B, Babin P, Germain T et al (1999) High-dose chemotherapy with hematopoietic stem cell transplantation in adults with bone marrow relapse of medulloblastoma: report of two cases. Bone Marrow Transplant 24(12):1347–1349

    Article  PubMed  CAS  Google Scholar 

  44. Graham ML, Herndon JE 2nd, Casey JR, Chaffee S, Ciocci GH, Krischer JP et al (1997) High-dose chemotherapy with autologous stem-cell rescue in patients with recurrent and high-risk pediatric brain tumors. J Clin Oncol 15(5):1814–1823

    PubMed  CAS  Google Scholar 

  45. Cottu PH, Giacchetti S, Mignot L, Epardeau B, Visot B, Extra JM et al (1994) High dose chemotherapy with stem-cell transplantation in a metastatic medulloblastoma in an adult: a case report and review of the literature. J Neurooncol 18(1):19–23

    Article  PubMed  CAS  Google Scholar 

  46. Lundberg JH, Weissman DE, Beatty PA, Ash RC (1992) Treatment of recurrent metastatic medulloblastoma with intensive chemotherapy and allogeneic bone marrow transplantation. J Neurooncol 13(2):151–155

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

The methods described in this publication comply with the current laws of Canada.

Funding

The authors did not receive any funding to carry out this research.

Author information

Authors and Affiliations

  1. Guideline Utilization Resource Unit, Alberta Health Services, Cancer Care, 1331 29th Street, NW, Calgary, Alberta, T2N 4N2, Canada

    Xanthoula Kostaras

  2. Department of Oncology, Tom Baker Cancer Centre, 1331 29th Street, NW, Calgary, Alberta, T2N 4N2, Canada

    Jacob C. Easaw

Authors
  1. Xanthoula Kostaras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacob C. Easaw
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xanthoula Kostaras.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kostaras, X., Easaw, J.C. Management of recurrent medulloblastoma in adult patients: a systematic review and recommendations. J Neurooncol 115, 1–8 (2013). https://doi.org/10.1007/s11060-013-1206-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-013-1206-3

Keywords

Search

Navigation