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Radiation Therapy in High-Grade Gliomas

  • Frank Saran
  • Liam Welsh
  • Delali Adjogatse
Living reference work entry
First Online:

Abstract

High grade gliomas (HGG) account for the majority of primary malignant brain tumors in adults with increasing incidence in age, peaking in the 75–84 age group. Glioblastoma (GB) is the most frequently occurring subtype, followed by anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), and mixed anaplastic oligoastrocytoma (AOA). Since 2016 a new WHO classification has radically changed our understanding of gliomas and introduced a molecular classification system allowing for future, more personalized, treatment approaches.

As the incidence of HGG increases with advancing age, selection of optimal treatment is complicated by preexisting comorbidities and deteriorating performance status. HGG are aggressive tumors which are best managed with a combined modality approach. Maximal surgical resection is associated with improved survival and favorable neurological improved outcome. However, due to the infiltrative nature of HGG, a complete microscopic clearance is rarely possible.

Radiotherapy post surgery  has been the mainstay of treatment for HGG for several decades. Involved field radiotherapy is now the standard approach used to maximize coverage of infiltrative tumor cells, while limiting the volume of normal brain tissue irradiated. Dose escalation above 60Gy, hypo- or hyper-fractionation has not shown any additional benefit. The introduction of concomitant and adjuvant temozolomide to radical radiotherapy has provided a modest but significant improvement in overall survival for patients with GB.

Despite optimal treatment, the prognosis for HGG remains poor with limited treatment options at recurrence. Additional molecular pathways identified in the development of HGG are now the target for novel therapies, which may potentially improve the prognosis of what remains to be a challenging and highly fatal disease.

Keywords

Radiotherapy High grade glioma Malignant glioma Personalised medicine Target volume definition 
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Authors and Affiliations

  1. 1.Department of Radiotherapy and Neuro-oncologyRoyal Marsden Hospital NHS Foundation TrustSuttonUK

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