Medulloblastoma staging

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

Overview

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

Modified Chang's Staging of Medulloblastoma

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

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 site
M3	Gross nodular seeding present in the spinal subarachnoid space
M4	Metastasis present outside the cerebrospinal axis

Risk Stratification Criteria

• Medulloblastoma may be stratified based on the tumor stage, patient age, and the extent of any previous surgical resection into either a standard risk group of patients or a high risk group of patients.
• The risk stratification criteria may help predict the protocol that should be used for the treatment of medulloblastoma patients.
• The table below demonstrates the risk stratification criteria for medulloblastoma patients:

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
Stage according to modified Chang's system	M0 stage confirmed by MRI and CSF sampling	M1-M3 stage or presence of leptomeningeal seeding