Medulloblastoma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]Haytham Allaham, M.D. [3]

Overview

The staging of medulloblastoma is based on the modified Chang's staging system. Medulloblastoma patients are risk stratified into either a standard risk group or a high risk group based on the tumor stage, the patient's age, and the extent of any previous surgical resection.[1][2]

Modified Chang's Staging of Medulloblastoma

The staging of medulloblastoma is based on the modified Chang staging system.[1]

T: Primary Tumor

T Description
TX Primary tumor cannot be assessed
T0 There is no evidence of primary tumor
T1 Tumor size <3 cm in diameter
T2 Tumor size ≥3 cm in diameter with no evidence of extension
T3a Tumor size >3 cm in diameter with extension into aqueduct of Sylvius or foramen of Luschka
T3b Tumor size >3 cm in diameter with definite spread into the brain stem
T4 Tumor size >3 cm in diameter with extension past aqueduct of Sylvius or down past foramen magnum

M: Distant Metastasis

M Description
M0 No evidence of metastasis
M1 Microscopic tumor cells present in the cerebrospinal fluid
M2 Gross nodular seeding present intracranially beyond the primary tumor site
M3 Gross nodular seeding present in the spinal subarachnoid space
M4 Metastasis present outside the cerebrospinal axis

Risk Stratification

  • Medulloblastoma patients are risk stratified into either a standard risk group or a high risk group based on the tumor stage, the patient's age, and the extent of any previous surgical resection.[3]
  • Risk stratification determines the protocol of management used for medulloblastoma patients.
  • The table below demonstrates the risk stratification for medulloblastoma patients:[3][2]
Parameters Standard Risk Group High Risk Group

Age

Patients older than 3 years of age
Patients younger than 3 years of age

Extent of previous surgical resection

<1.5 cm² residual tumor after resection
Subtotal resection or >1.5 cm² residual tumor after resection

Tumor stage

M0 stage confirmed by MRI and CSF sampling
M1-M3 stage or presence of leptomeningeal seeding

References

  1. 1.0 1.1 Harisiadis L, Chang CH (1977). "Medulloblastoma in children: a correlation between staging and results of treatment". Int J Radiat Oncol Biol Phys. 2 (9–10): 833–41. PMID 597384.
  2. 2.0 2.1 Medulloblastoma staging. Wikibooks(2015) https://en.wikibooks.org/wiki/Radiation_Oncology/Medulloblastoma/Staging Accessed on September, 282015)
  3. 3.0 3.1 Bartlett F, Kortmann R, Saran F (2013). "Medulloblastoma". Clin Oncol (R Coll Radiol). 25 (1): 36–45. doi:10.1016/j.clon.2012.09.008. PMID 23245832.