The progress that has been made in the treatment of the patient with medulloblastoma is gratifying. Survival for those who fall into the lower risk category probably exceeds 75%. For this degree of success, however, patients and their families have had to pay a price in terms of suffering the deleterious late effects of treatment. With sophisticated neuroimaging techniques diagnoses are now being made in a timely fashion and surgical mortality has been reduced to almost zero in most major medical centers. Radiation therapy and chemotherapy regimens have been increasingly successful, and further refinements of treatment are to be expected with the completion of randomized cooperative group trials. It is time to focus on means of achieving similar, or even better results, with reduced doses of neuraxis radiation, whenever possible, especially in the younger patient.
