Chemoradiotherapy: Radiation Total Dose and Fractionation

  • Silvia ChiesaEmail author
  • Mario Balducci
  • Milena Ferro
  • Anna Rita Alitto
  • Vincenzo Valentini
Part of the Current Clinical Pathology book series (CCPATH)


Glioblastoma Multiforme (GBM) is the most common brain tumor. The standard care is surgery followed by radiotherapy plus concurrent and adjuvant temozolomide. Despite technical advances in surgery and in radiotherapy, the prognosis remains dismal with a median overall survival of around 14 months. The standard radiation total dose is 60 Gy, while the optimal dose and fractionation in elderly patients remain to be defined. At diagnosis, several studies explored altered fractionation, dose escalation strategies using techniques such as intensity modulated radiotherapy, radiosurgery, or brachytherapy, but none demonstrated a survival advantage. The optimum management at recurrence has not been established. A variety of treatment, as well as supportive care, should be considered in multidisciplinary setting in order to perform an appropriate and personalized treatment. New research trends in genomics have significantly improved our knowledge of the molecular features of GBM, and this has translated into the identification of specific targets for potential treatments. Although the results are promising, the role of new strategies in the management of these patients remains to be defined by prospective randomized trials.


Conventional postoperative radiation therapy Radiation volume Total dose Fractionation Chemotherapy Target therapies Re-irradiation Combined modalities Elderly Research trends 


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Silvia Chiesa
    • 1
    Email author
  • Mario Balducci
    • 1
  • Milena Ferro
    • 1
  • Anna Rita Alitto
    • 1
  • Vincenzo Valentini
    • 1
  1. 1.Radiation Oncology DepartmentGemelli-ART, Università Cattolica S. CuoreRomeItaly

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