The series of medulloblastoma reported by Gajjar et al.23 included 103 high-risk patients treated with uniform therapy: Post-surgical irradiation was followed by 4 courses of vincristine, cisplatin, and cyclophosphamide at a myeloablative dose.16 In their most recent analysis, metastatic disease, LC/A histology, MYC, and MYCN amplification were shown to be adverse prognostic factors although residual disease alone was not. This evidence concerns the gene MYC and metastatic neoplasm.