Medulloblastoma chapter - past perspectives and future directions

Medulloblastoma, once considered a uniform entity, is now accepted as a complex and heterogeneous group of tumors requiring a nuanced and multidisciplinary approach to diagnosis and treatment. The now four recognized primary subgroups have distinct genetic, epigenetic, and clinical characteristics that influence prognosis and treatment responses necessitating subgroup-specific strategies. Advances in diagnostics and risk stratification, largely driven by a deeper understanding in tumor biology, has led to an overall improvement in survival (>70 %), through risk-adapted treatment strategies. Contemporary clinical approaches incorporate a multimodality treatment strategy, integrating surgery, radiotherapy and intensive chemotherapy, each of which is associated with significant short- and long-term morbidity. Novel targeted therapeutics continue to be developed, investigated and explored in vitro, in vivo and through clinical trial design, particularly in the high risk and relapsed settings. As the therapeutic landscape continues to evolve, combining conventional therapies with these approaches holds promise to improve clinical outcomes. These innovations and developments expanding all disciplines aim to continue to provide precision-based care and enhance survival outcomes across all subgroups whilst mitigating the significant long-term burden of treatment-related sequelae disproportionately experienced by medulloblastoma survivors.