Radiation therapy.

Radiation therapy is a main pillar in the multimodal treatment of gliomas. However, application of radiation has to be adapted to the distinct characteristics of the various glioma subtypes, with respect to dosing, time-point of irradiation, choice of treatment technique, and more recently, of radiation quality.Treatment of low-grade gliomas has been characterized by much controversy, which is still ongoing. For anaplastic gliomas, addition of chemotherapy to radiation alone is currently being discussed and is evaluated in prospective trials. For glioblastomas, a change in treatment paradigm has taken place with the alkylating agent temozolomide, which could increase survival significantly for the first time in many centuries. Moreover, the first steps toward pretreatment stratification have been established by defining the role of MGMT-promotor methylation for treatment response and outcome.Over the last few years, particle therapy with protons and carbon ions has become available. These new radiation qualities now offer promising treatment alternatives that will be evaluated within clinical studies in the near future and have the potential to further improve outcome in patients with gliomas.