Fractionated Radiotherapy of Intracranial Gliomas.

Fractionated radiotherapy (FRT) plays a critical role in the management of gliomas. For glioblastoma, the irradiation dose of 60 Gy in 30 fractions with concomitant and adjuvant temozolomide is currently considered as a standard of treatment, and further dose escalation has failed to be of benefit in clinical trials. Hypofractionated radiation schedules may be applied in elderly patients or those with poor performance status. For anaplastic gliomas, the high-risk region is typically irradiated to a total dose of approximately 60 Gy in 1.8-2 Gy per fraction. For patients with 1p/19q co-deleted WHO grade III tumors (i.e., anaplastic oligodendrogliomas), FRT alone is currently not considered as an acceptable therapeutic approach. The use of adjuvant irradiation for low-grade gliomas is controversial; in high-risk patients, treatment with a dose of 45-54 Gy in 1.8 Gy per fraction is usually used. Long-term risks of FRT include radiation necrosis, neurocognitive decline, and neuroendocrine dysfunction. Modern techniques, such as intensity-modulated radiation therapy (IMRT) and proton therapy allow for modifications in radiation dosing and delivery while improving conformality and limiting irradiation of normal tissue.