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Adjuvant Treatments for Medulloblastomas in Children

This page was last updated on January 25th, 2023

Staging Disease for Adjuvant Treatment

Postoperative treatment algorithms are affected by stratification of patients into high-risk and average-risk groups, as defined below (17).

Average risk

  • Older: Age >3 years.
  • Focal disease: No leptomeningeal seeding (ventricular spinal, or subarachnoid) on MRI. Negative CSF cytology (obtained > 10 days postoperatively). No extraneural metastasis (i.e., bone, lungs).
  • Good resection: < 1.5 cm2 of residual tumor on postoperative MRI.

High risk

  • Young: Age < 3 years.
  • Disease spread: Evidence of spread through CSF space or metastasis to extraneural sites.
  • Significant residual disease: Residual disease > 3 cm3.

Radiation Therapy

  • 2340–3600 cGy with boost: All patients who are at least 3 years of age should receive postoperative external beam radiation therapy (range, 2340–3600 cGy of craniospinal radiation) with a boost to the posterior fossa (typically to approximately 5400 cGy)  (2, 7, 21, 26).
  • Reduced dose: A reduction in the dose of radiation therapy can be considered in average-risk patients.
  • Younger than 3 years: Reduced-dose radiation therapy or no radiation therapy can be considered in patients less than 3 years of age.


  • All patients: Chemotherapy should be given to all patients. Various regimens have been used (1).
  • Myeloablative chemotherapy:  In children younger than 3 years and in patients with recurrent disease, high-dose chemotherapy with stem-cell rescue may be considered (4).

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