Why it’s time for a change in the management of adolescent and adult medulloblastoma

ABSTRACT Introduction: Medulloblastoma is the most common malignant brain tumor in children but rare in adults. While pediatric tumors have been heavily studied, adult medulloblastoma remains an orphan disease, lacking dedicated studies. Older adolescents and young adults, in the gap between adult and pediatric treatment philosophies, represent an especially vulnerable population of patients. There is currently no consensus on the best treatment and virtually no data on impact on quality of life of patients with medulloblastoma diagnosed in adulthood. Areas covered: In this review, we summarize recent findings that illustrate the differences between pediatric and adult medulloblastoma, discuss treatment approaches, outline challenges and contemplate future directions of care for adolescents and adults with medulloblastoma. Expert commentary: Recent studies showed that adult and pediatric tumors are biologically and clinically distinct, as is the spectrum of treatment-related toxicities between the two age groups. While we should use lessons learned from pediatric studies to improve care of older patients, it is important to take into account age-specific prognostic factors and response to therapy. Given the rarity of the disease and the many questions that remain unanswered, it seems crucial to address them in multi-institutional prospective trials, ideally through cooperation between pediatric and adult institutions.