**15. Outcome**

Though the outcomes need to be judged cautiously because of the marked heterogeneity between studies, overall outcome of medulloblastoma patients has improved tremendously over the last decades. Still, outcome in a good number of patients with metastatic disease, adverse molecular or cytogenetic features, infants and relapsed or refractory patients remains depressing.

Many factors play role in outcome of medulloblastoma patients and outcomes have been variable in different series. The outcome has gradually improved from survival from onset to death of 8–9 months in 1930s to 54% 3-year survival in 1950s, about 75% 5-year survival in 1980s [71]. Till the last decade the five-year EFS and OS has raised to 81 ± 2.1 and 86 ± 9%, respectively [68]. Among the factors that play role in poor outcome, the noteworthy are younger age, larger residual tumor volume after surgery, inadequate dose of radiotherapy, presence of metastatic disease at diagnosis, presence of hydrocephalus, anaplastic or large cell histology, insufficient chemotherapy, MYC amplification or expression, 17p loss or 1q gain, and tumors of Group 3 or Shh subgroup with TP53 mutations. On the contrary, patients having monosomy 6, mutation of CTNNB1, and trkC expression demonstrate a favorable outcome [6, 9, 33, 41, 49, 59]. Generally, OS for children with medulloblastoma are reported as 50–60%, whereas for average-risk and high-risk patients OS is 70–80 and 30–40% respectively [8, 119].
