New stratification for early childhood medulloblastoma

Radiotherapy (RT) remains the mainstay of medulloblastoma treatment but its impact on neurocognitive outcome of young children is massive. In this age group, the main challenge is to limit the cost of cure by deferring, completely avoiding or at least reducing RT (field or dose) without jeopardizing survival. In the past, survival of young children with medulloblastoma was somewhat lower than in older children treated with standard craniospinal RT. Apart from the decrease of RT other causes can be discussed: differences in tumor biology, higher frequency of metastases, inclusion of others embryonal tumors such as atypical teratoid/rhabdoid tumor (ATRT) or embryonal tumor with multilayered rosettes (ETMR) with known worse prognosis.