INTRODUCTION: Malignant brain tumors have been reported to occur after childhood irradiation more frequently than in the nonirradiated population. DISCUSSION: In this study, we report the case of a 15-year-old boy treated for medulloblastoma with surgery and craniospinal radiotherapy, who developed a meningioma 18 years after initial treatment and subsequently an anaplastic astrocytoma 23 years after primary treatment. The meningioma was resected without complications. The patient is currently alive but with recurrent astrocytoma after a complete remission on temozolomide monotherapy. Second malignancies are a rare, potentially devastating risk in cancer survivors, with risk continuing lifelong.