Medulloblastoma

Medulloblastoma is the most common malignant brain tumor of childhood, where current treatments consist of surgery followed by craniospinal irradiation and/or multimodal chemotherapy. Survival rates with this approach have been stagnant for decades, but there has been an increasing appreciation of the long-term sequelae in survivors. The advent of integrated genomics has changed our understanding of medulloblastoma, where it is now universally accepted that it is comprised of at least four distinct entities termed WNT, SHH, Group 3, and Group 4. These four subgroups are molecularly distinct with unique genetics, driver pathways, demographics, and outcomes. Herein, we review the historical and upcoming approach to medulloblastoma highlighting how incorporating molecular stratification can potentially result in improved functional outcomes while also acknowledging the immense challenge of how to translate these findings to the clinic.