Radiotherapy Strategies for High-Grade Gliomas
Summary
High-grade gliomas represent an aggressive subset of primary brain tumours for which radiotherapy remains a foundational therapy. Standard practice involves fractionated external-beam radiotherapy up to 60 Gy in conjunction with temozolomide chemotherapy. Technological advances have enabled highly conformal techniques—such as intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT)—to sculpt dose distributions around irregular tumour beds while sparing adjacent critical structures. Adaptive radiotherapy, facilitated by integrated imaging platforms, allows for plan adjustments in response to postoperative cavity changes or daily anatomical shifts. Emerging approaches include magnetic resonance guided radiotherapy (MRgRT), which provides real-time anatomical and physiological imaging for on-table replanning, and simultaneous integrated boost (SIB) regimens that concentrate higher doses on regions of greatest risk. Together, these strategies aim to enhance local control, minimise neurotoxicity and improve patient quality of life worldwide.
Research from Nature Portfolio
A multi-institutional analysis investigated high-dose concomitant boost radiotherapy versus conventional fractionation for newly diagnosed glioblastoma. In the boost arm, selected subvolumes received escalated doses up to 69 Gy within the standard 30-fraction course. With a median follow-up of 16 months, the boosted regimen correlated with a significant improvement in overall survival on multivariate analysis, a result that persisted after inverse probability weighting. Progression-free survival showed favourable trends. These findings support the feasibility of integrated boost techniques and underscore the need for prospective, protocol-driven trials to establish optimal dose intensification schemes and assess long-term functional outcomes.
Radiotherapy Strategies for High-Grade Gliomas publication trend
The graph below shows the total number of articles in radiotherapy strategies for high-grade gliomas across all publications each year (not limited to Nature Index journals).
Technical terms
Gross tumour volume (GTV): the visible extent of tumour delineated on imaging.
Clinical target volume (CTV): the GTV plus a margin to encompass potential microscopic disease.
Intensity-modulated radiation therapy (IMRT): a delivery technique that varies beam intensity across each field for conformal dose shaping.
Volumetric-modulated arc therapy (VMAT): an IMRT variant delivering dose through continuous gantry rotation to improve efficiency.
Magnetic resonance guided radiotherapy (MRgRT): an approach integrating real-time MRI with dose delivery for adaptive planning.
Simultaneous integrated boost (SIB): a strategy delivering higher radiation dose to high-risk subregions within the same fractionation schedule.
References
- Simulated Adaptive Radiotherapy for Shrinking Glioblastoma Resection Cavities on a Hybrid MRI–Linear Accelerator. Cancers (2023).
- The need of radiotherapy optimization for glioblastomas considering immune responses. Japanese Journal of Radiology (2023).
- Simultaneous boost radiotherapy versus conventional dose radiotherapy for patients with newly diagnosed glioblastoma: a multi-institutional analysis. Scientific Reports (2024).
- Coplanar versus noncoplanar intensity‐modulated radiation therapy (IMRT) and volumetric‐modulated arc therapy (VMAT) treatment planning for fronto‐temporal high‐grade glioma. Journal of Applied Clinical Medical Physics (2012).
- Evaluating changes in radiation treatment volumes from post-operative to same-day planning MRI in High-grade gliomas. Radiation Oncology (2012).
- MR-Guided Radiotherapy for Brain and Spine Tumors. Frontiers in Oncology (2021).
- Canadian Recommendations for the Treatment of Glioblastoma Multiforme. Current Oncology (2007).
About these summaries
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