Chemotherapy Plus Proton or Photon Radiation on a Trial

Up-front radiation offers improved disease-free survival. "Historic" indications for adjuvant therapy in this case would include size > 6 cm, age > 40 years, and an astrocytic component (1, 2). Regardless, many practitioners might hesitate to offer adjuvant radiation (or referral to radiation oncology), primarily out of fear of radiation-induced cognitive dysfunction. Indeed, the presence of an isocitrate dehydrogenase mutation portends long-term survival, presumably placing this patient at risk for long-term radiation-induced cognitive toxicities.

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