Current and future strategies in the management of medulloblastoma in adults.

Medulloblastoma in adults are rare and differ from their childhood counterparts in terms of tumor site (hemispheric location), histological subtype (desmoplastic variant), lower incidence of metastatic spread and frequent late relapses. As in children the presence of metastatic disease is of major prognostic significance. The role of different histological subtypes and molecular genetic/biological markers is unknown and deserves further investigations. The therapeutic strategies are essentially based on experiences in childhood medulloblastomas. Surgery followed by irradiation of the entire central nervous system followed by a boost to the posterior fossa is the cornerstones of treatment. A sufficient dose prescription and a high quality of treatment are a prerequisite for an optimal tumor control. Unlike in children the role of chemotherapy is an open question and requires prospective investigations. The forthcoming EORTC-study is addressing this issue.