The [[gold standard]] for [[High-Grade Glioma treatment]] recommends beginning [[chemoradiation]] within 6 weeks after. [[glioblastoma surgery]].

The standard of care management for newly diagnosed [[glioblastoma multiforme]] (Glioblastoma) includes [[surgery]], [[radiation]], [[temozolomide]] (TMZ) [[chemotherapy]], and [[tumor treating fields]]
((Stupp R, Taillibert S, Kanner A et al (2017) Effect of tumortreating
fields plus maintenance temozolomide vs maintenance
temozolomide alone on survival in patients with glioblastoma: a
randomized clinical trial. JAMA 318:2306–2316)). 

From [[2005]] [[chemotherapy]] with [[temozolomide]], according to [[Stupp protocol]] 
((Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO; European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy
Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005 Mar 10;352(10):987-96. PubMed PMID: 15758009.))
, particularly in patients that demonstrate [[MGMT promoter methylation]]. 

Conflicting reports have emerged regarding the importance of the time interval between these 2 treatments and there is no clear association between duration from surgery to initiation of chemoradiation on [[overall survival]] (OS).
((Osborn VW, Lee A, Garay E, Safdieh J, Schreiber D. Impact of Timing of
Adjuvant Chemoradiation for Glioblastoma in a Large Hospital Database.
Neurosurgery. 2018 Nov 1;83(5):915-921. doi: 10.1093/neuros/nyx497. PubMed PMID: 
29092047.
)).
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{{ ::anaplastic_astrocytoma.jpg?350|}}

Treatment consists of [[maximal safe resection]], [[radiotherapy]], and [[chemotherapy]]. Trials of patients with newly diagnosed grade III glioma have shown survival benefit from adding chemotherapy to radiotherapy compared with initial treatment using radiotherapy alone. Both [[temozolomide]] and the combination of [[procarbazine]], [[lomustine]], and [[vincristine]] provide survival benefit. In contrast, trials that compare single modality treatment of chemotherapy alone with radiotherapy alone did not observe survival differences. Currently, for patients with grade III gliomas who require postsurgical treatment, the preferred treatment consists of a combination of radiotherapy and chemotherapy
((van den Bent MJ, Smits M, Kros JM, Chang SM. Diffuse Infiltrating
Oligodendroglioma and Astrocytoma. J Clin Oncol. 2017 Jul 20;35(21):2394-2401.
doi: 10.1200/JCO.2017.72.6737. Epub 2017 Jun 22. Review. PubMed PMID: 28640702.
)).
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After treatment, all patients have to undergo brain magnetic resonance imaging procedure quarterly or half-yearly for 5 years and then on an annual basis. In patients with recurrent tumor, wherever possible re-resection or re-irradiation or chemotherapy can be considered along with supportive and palliative care. High-grade malignant glioma should be managed in a multidisciplinary center