Radiation Oncology Treatments in Glioma Patients: From Standard Protocols to New Directions

Radiotherapy (RT) is a crucial component in the management of gliomas, and its use is tailored to the specific molecular and histopathological features as per the WHO 2021 classification. Advances in radiotherapy techniques, such as IMRT, VMAT, adaptive treatments, and proton therapy, have improved precision and reduced side effects, including neurocognitive decline. While generally no benefit has been highlighted in the use of radiation doses greater than 60 Gy, both conventional fractionated (cFRT) and hypo-fractionated (HFRT) schemes are accepted in clinical practice. Integration with chemotherapy and novel therapies continues to evolve, enhancing the efficacy of treatment and patient outcomes. This chapter emphasizes the importance of precise radiotherapy techniques and treatment protocols to improve outcomes while minimizing adverse effects in glioma patients. Specifically, it focuses on radiotherapy protocols for adult-type diffuse gliomas, which are divided by histological type and grading, and highlights both standard and evolving treatment practices.