期刊
JOURNAL OF NEUROSURGERY-PEDIATRICS
卷 24, 期 4, 页码 353-363出版社
AMER ASSOC NEUROLOGICAL SURGEONS
DOI: 10.3171/2019.5.PEDS18381
关键词
medulloblastoma; oncology; neurooncology; genomics; metastasis
资金
- NIH [R01CA148699, R01CA159859]
- Pediatric Brain Tumor Foundation
- Terry Fox Research Institute
- Canadian Institutes of Health Research
- CureSearch Foundation
- b.r.a.i. n.child
- Meagan's Walk
- The Swifty Foundation
- Genome Canada
- Genome British Columbia
- Genome Quebec
- Ontario Research Fund
- Worldwide Cancer Research
- V Foundation for Cancer Research
- Ontario Institute for Cancer Research - Government of Ontario
- Canadian Cancer Society Research Institute Impact grant
- Stand Up To Cancer (SU2C) St. Baldrick's Pediatric Dream Team Translational Research Grant [SU2C-AACR-DT1113]
- SU2C Canada Cancer Stem Cell Dream Team Research Funding by the Government of Canada through Genome Canada [SU2C-AACRDT-19-15]
- Government of Ontario
- Garron Family Chair in Childhood Cancer Research at The Hospital for Sick Children
- University of Toronto
- Canadian Institutes of Health Research Vanier Canada Graduate Scholarships
- University of Toronto Clinician Investigator Program
- University of Toronto SurgeonScientist Training Program
Medulloblastoma is the most common pediatric malignant brain tumor. Advances in molecular profiling have uncovered significant heterogeneity among medulloblastomas and led to the identification of four distinct subgroups (wingless [WNT], sonic hedgehog [SHH], group 3, and group 4) that represent distinct disease entities in both underlying biology and clinical characteristics. The rapidly expanding repertoire of tools to study developmental and cancer biology is providing a wealth of knowledge about these embryonal tumors and is continuously refining the understanding of this complex cancer. In this review, the history of discovery in medulloblastoma is discussed, setting a foundation to outline the current state of understanding of the molecular underpinnings of this disease, with a focus on genomic events that define the aforementioned subgroups and evolving areas of focus, such as the cell of origin of medulloblastoma and medulloblastoma subtypes. With these recent discoveries in mind, the current state of medulloblastoma treatment and clinical trials is reviewed, including a novel risk stratification system that accounts for the molecular biomarkers of patients with a high risk for refractory disease. Lastly, critical areas of focus for future basic science and clinical research on this disease are discussed, such as the complexities of medulloblastoma metastases and recurrence as well as the priorities and strategies to implement in future clinical trials.
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