Radiotherapy intensification for glioblastoma: enhancing the backbone of treatment.

Given the impact of radiotherapy on survival outcomes for patients with glioblastoma (GBM), intensification of radiotherapy through dose-escalation and/or dose-per-fraction escalation has been an important area of ongoing investigation. Prior to the introduction of temozolomide, radiotherapy intensification beyond 60-Gy conventionally fractionated radiotherapy did not yield a survival benefit. With the emergence of temozolomide and its radio-sensitizing properties, as well as greater understanding of the patterns of first progression after 60-Gy radiotherapy, hypotheses regarding the impact of radiotherapy intensification have arisen. This article will discuss ongoing and future investigations of radiotherapy intensification in the modern temozolomide era of GBM management. These efforts have focused on better radiotherapy delivery techniques and/or improved tumor imaging to identify high-risk regions of progression.