History of Management of Medulloblastomas in Children

Understanding of Disease

• 1930 – Cushing’s series published: The first large series of operations for medulloblastoma was reported by Cushing, who had operated on 61 patients with medulloblastoma by 1930, only 5 years after medulloblastoma was described as a pathological entity in 1925 (28). Cushing recognized that survival was longer for patients after radical surgical removal than after biopsy (mean of 17 months after radical surgery vs. 6 months after biopsy).
• 1953 – reported effectiveness of radiation: Prior to the era of modern imaging, radiation therapy, and chemotherapy, medulloblastoma was considered a fatal disease. The first major breakthrough, in 1953, came when Patterson and Farr reported that craniospinal irradiation significantly prolongs survival (29).
• 1990 – reported effectiveness of chemotherapy: In 1990, Evans et al. first reported a randomized trial demonstrating the benefits of chemotherapy added to radiation therapy over radiation therapy alone (23).
• Modern multimodality treatment curative: Modern treatment paradigms incorporating maximal safe surgical resection, craniospinal radiation therapy, and chemotherapy have changed medulloblastoma from a fatal disease to one in which most patients achieve long-term survival.