Chemotherapy for medulloblastoma in adults

Medulloblastomas are malignant brain tumors that are rare in adults. The standard of care upfront treatment for adult medulloblastoma consists of maximal safe surgical resection followed by craniospinal radiation, usually with adjuvant systemic chemotherapy. Treatment decisions are based on staging, molecular diagnostics, risk stratification, and individual patient risk factors. Clinical trials that specifically compare chemotherapy regimens in adults are lacking, and treatment protocols are often extrapolated from studies in children. Toxicities related to chemotherapy in adults have historically limited the dose and duration of available therapies. Molecular diagnostics have improved dramatically in the past few decades, helping delineate medulloblastoma subgroups and subtypes. Targeted therapies may present a viable option for tumors with certain molecular features, such as pathway-specific inhibitors of Smoothened for medulloblastoma with mutations in the sonic hedgehog pathway, the most frequent subgroup in adults. More research studies are required to further establish therapy recommendations and improve patient outcomes.