RAMB - Julho 2016

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Collange NZ et al.
298 Rev Assoc Med Bras 2016; 62(4):298-302
GUIDELINES IN FOCUS
Treatment of medulloblastoma in children and adolescents
Tratamento do meduloblastoma em crianças e adolescentes
Authorship: Sociedade Brasileira de Neurocirurgia
Participants: Nelci Zanon Collange1, Silvana de Azevedo Brito1, Ricardo Rezende Campos1,
Egmond Alves Silva Santos 1, Ricardo Vieira Botelho 1
Conflict of interest: none
1Sociedade Brasileira de Neurocirurgia
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standard-
ize procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, de-
pending on the conditions and the clinical status of each patient.
Introduction
Medulloblastoma is the most common brain tumor in
children from zero to four years old. It is rare in adults
and 75% of cases occur in patients younger than 16 years.1
Treatment includes surgery, chemo and radiothera-
py. Controversy persists about the need for full withdraw-
al, need and indication of reoperation for residual lesion,
the role of neuraxial chemotherapy and radiotherapy, and
best treatment of hydrocephalus, which often accompa-
nies these tumors.
This guideline is addressed to physicians, health
managers and decision makers in the treatment of this
disease.
The guideline was based on clinical issues that were
specified for the type of patient, and the method of devel-
opment for this guideline included the databases that were
searched, the electronic search strategy, types of study un-
der evaluation, and the criteria used to produce recommen-
dation. The clinical issues were defended by the authors
(group of neurosurgeons of the Pediatric Neurosurgery De-
partment, Sociedade Brasileira de Neurocirurgia – Brazil-
ian Society of Neurosurgery). The electronic search strate-
gies for each clinical question are described in Annex I. The
number after each strategy reveals the number of articles
initially retrieved by the strategy. Regarding the extraction
of data, items ultimately identified as related to the issue
were described in the text. The others were excluded because
they did not specifically address the issue.
Objective
To define the best alternatives for diagnosis and treat-
ment of medulloblastoma in children and adolescents,
and recommend them where possible.
Method
Patients for whom the guideline was constructed are chil-
dren, adolescents and young adults aged between 0-18
years with diagnosis of medulloblastoma.
The methods for developing this guideline were those
involved in evidence-based medicine, establishing prima-
ry trials as the studies with the best quality of existing in-
formation for decision making.
Databases searched included the Medline, 1966 to
2013, and the Central Cochrane Register of Controlled Tri-
als, using the terms of the standard vocabulary (MESH)
and terms from the text: The references obtained in the
primary studies were evaluated in search of other work, as
well as works of knowledge of the authors of the guideline.
The correspondence between the degree of recom-
mendation and the strength of scientific evidence is de-
scribed after extracting data of each work (in parenthe-
ses), and was classified as follows:
A. Experimental or observational studies of higher con-
sistency.
B. Experimental or observational studies of lower consis-
tency.
C. Case reports and non-controlled studies.
D. Opinions without critical evaluation, based on con-
sensus, physiological studies, or animal models.
Size and direction of the effect, benefits, side effects and
risks were considered to develop these recommendations.
Articles were selected according to the hierarchy of
evidence produced, with priority given to randomized tri-
als and, in their absence, those with highest level of evi-
dence available.