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Radiotherapy for malignant glioma

The management of malignant glioma presents challenges for neurosurgeons and oncologists alike. Surgery with postoperative radiotherapy remains the “gold standard” treatment for this group of patients. Neurosurgical procedures are essential for accurate diagnosis, and surgical decompression relieves raised intracranial pressure and improves neurological deficits. Despite optimal surgical resection, half of patients die within three months of the operation. Postoperative radiotherapy increases median survival to between nine and 12 months, but, by two years, 90% of patients are dead.1 Adjuvant chemotherapy provides a small survival advantage at one year, but this disappears by two years.

Well conducted clinical trials provide convincing evidence that patients' age, histology (anaplastic astrocytoma or glioblastoma multiforme), and degree of functional impairment wrongly influence the duration of survival.2 They offer a rational basis for selecting treatment for individual patients. Disabled patients with glioblastoma multiforme aged 60 years or over will derive limited benefit from aggressive treatment.3 Conversely a 35 year old patient with post-resection histology of anaplastic astrocytoma and minimal neurological deficit has a high probability of remaining well for 18 months or longer if treated with the optimal schedule of high dose radiotherapy. In both of these scenarios it is important to ensure that the toxicity of treatment does not outweigh the survival benefit.

The effect of radiation on the brain has a classic time dependent …