ABSTRACT
This chapter reviews current indications and evidence supporting image-guided hypofractionated stereotactic radiotherapy (IG-HSRT) for both newly diagnosed and recurrent glioblastoma, technical approaches to the planning and delivery of IG-HSRT, potential toxicities and their management, and controversies and future directions for the use of IG-HSRT for malignant glioma. The role of adjuvant radiation therapy following maximal surgical resection was established in the 1970s in the BTSG studies. Technological advances in the delivery of RT enable the safe delivery of larger doses of radiation via IG-HSRT. The use of IG-HSRT in the recurrent setting affords the ability to deliver higher fractional doses of radiation to tumor that has demonstrated itself to be radioresistant. The risk of radionecrosis is typically proportional to the irradiated treatment volume, and thus clinical judgment should be practiced in selecting appropriate patients and target volumes for IG-HSRT.
