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High-grade tumors
Source: Central Nervous System Tumors Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: March 28, 2025 · Captured 2026-09-09.
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Context: Treatment Option Overview for Primary CNS Tumors / Primary CNS Tumors / Radiation therapy
Radiation therapy has a major role in the treatment of patients with high-grade gliomas.
Evidence (postoperative radiation therapy [PORT]):
A systematic review and meta-analysis of five randomized trials (plus one trial with allocation by birth date) comparing PORT with no radiation therapy showed a statistically significant survival advantage with radiation (risk ratio, 0.81; 95% CI, 0.74–0.88).[10][Level of evidence A1]
Source links and citations
A randomized trial comparing 60 Gy (in 30 fractions over 6 weeks) with 45 Gy (in 25 fractions over 4 weeks) showed superior survival in the first group (12 months vs. 9 months median survival; hazard ratio [HR], 0.81; 95% CI, 0.66–0.99). The accepted standard dose of EBRT for malignant gliomas is 60 Gy.[11][Level of evidence A1]
Source links and citations
EBRT using either 3-dimensional conformal radiation therapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) is considered an acceptable technique in radiation therapy delivery. Typically used are 2- to 3-cm margins on the MRI-based volumes (T1-weighted and fluid-attenuated inversion recovery [FLAIR]) to create the planning target volume.
Dose escalation using radiosurgery has not improved outcomes. A randomized trial tested radiosurgery as a boost added to standard EBRT, but the trial found no improvement in survival, quality of life, or patterns of relapse compared with EBRT without the boost.[12,13]
Brachytherapy has been used to deliver high doses of radiation locally to the tumor while sparing normal brain tissue. However, this approach is technically demanding and is less common since the advent of 3D-CRT and IMRT.
Publication references
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Preserved source evidence · Not medical advice