Radiation and re-irradiation for patients with glioblastoma multiforme

Multimodality therapy for GBM including maximal surgical resection and postoperative external beam radiation therapy (EBRT) with concomitant temozolomide (TMZ) chemotherapy represents the current standard approach to treatment. This chapter will review the role of radiation in the management of patients with GBM as well as the evidence that has guided its evolution. EBRT typically entails delivery of 60Gy in 30 treatments. Three dimensional conformal radiation therapy (3D-CRT) has resulted in reduction of normal tissue exposed to high doses of radiation whilst intensity modulated radiation therapy (IMRT) has further enhanced radiation dose delivery and critical adjacent normal tissue sparing. Special consideration for patients older than 65 year should be held, as modified RT/TMZ schemes might be more appropriate. Re-irradiation for tumor recurrence is safe and effective for selected patients.