Yes, Better you can try for radiotherapy with cranial nv protection and also dose calculation should me accurate.

 Thanks a lot  for guidance 

radiotherapy is your best bet with or without chemotherapy. The addition of the later being dependent on the ECOG performance of the patient 

Agree,radiotherapy is the treatment of choice.

Of course radiotherapy is choice specially with chemotherapy but it should be consider that expert surgeon who can resect tumor will help the patient more than anyone.

just aggressive resection of the tumor will improve patient's survival.

thank you all for your views n advice

Glioma outcome is very difficult to predict.

Radiotherapy to the brain stem should be stereotaxic radio surgery (gamma knife or cyberknife) to protect as much as possible the surrounding healthy tissu. In this area, the best radiotherapy is probably the proton therapy.

May I ask to consider with the radiologist to arrange for MR spectroscopy to differentiate low grade from high grade gliomas, if low grade, yes go for radiosurgery with Gamma Knife to have a sharp fall off of radiation dose, if high grade, the prognosis is much worse, gamma knife will not be the answer, you should consider 3-D conformal or IMRT radiation with conventional or less than conventional dose per fraction, i.e. 180-200 cGy per treatment.

Radiotherapy for brainstem gliomas is the therapy of choice.  It is used in preference to chemotherapy and surgery for children and adults.  There are some tumors (dorsally located and exophytic) that are amenable to resection.  Fractionated irradiation, using 1.8 - 2.0 Gy fractions to a dose of 54 Gy, and using relatively close radial margins (the tumor won't jump out and invade the clivus or the medial temporal lobes) and larger axial margins (about 2 cm should be fine), as that is how the tumor would spread (along the white matter pathways) is how margins should be allocated.  You should ask your dosimetrists/physicists to emphasize dose homogeneity--this can be achieved by using higher energy photons (10 or 15 MV, if available).  I ask my planners to try to achieve homogeneity of +/- 3%.  Finally, if possible, sparing the cochlear dose to about 40 Gy will help assure hearing is not overly compromised by this therapy.

thank you Gabriel,Khaled,Jonathan

Very helpful n detailed information

Just adding to Drs Karim and Knisely, the natural history and the radiation dose to be given will depend on the grade of the glioma. Though we have an upper dose limit of 54Gy for the brainstem  at 2Gy fractions [or upto 59Gy to 1 - 10cc of brainstem as per QUANTEC), we have to also consider that these predict risk of adverse events as TD 5/5 (5% at 5 yrs). So you have to take a call considering the probable life expectancy of this patient also.

Besides radiotherapy think of water-cooled local hyperthermia with achievable results especially in glioblastomas III-IV (oncothermia or celsius 24 applications).

I think it depends much on the character of tumor. Does the 

Besides conventional radiotherapy additionally you should think of  water-cooled deep-local hyperthermia (Oncothermia or Celsius 42) especially for high grade glioblastomas WHO III-IV and strictly before use of e.g. temozolamide to prevent the well known side effects of radiotherapy.

From the last fifty years the one and only useful treatment is Raditherapy. Ofcourse this 8s a palliative Rx. If it is a localized tumor Rx of choice is surgery. If it is diffuse pontine glioma Rx is radiotherapy. Either hypofractionated or total dose of 54 Gy can be used. In the last decade more than 200 regimns were proposed for treatment but none of them were superior to radiotherapy alone.

Thanks all for valuable opinions

Boswellia extract (LOX-inhibitor) can be applied for brain edema caused by brain tumors and radiation therapy and reduces the number of brain metastases. 

Within integrative therapy regimes in the concomitant treatment of glioblastomas we use capsuled Boswellia serrata (highest amount of boswellia acid) [400 mg capsules] up to 3400 mg/day to prevent and reduce brain edema with the effect, that we could reduce Dexamethason in asignificant way. Unfortunately we could`nt observe any effects in reducing metastases. Any other experiences?

Hello Martin,

what sort of metastases do you mean? Might depend on the etiology. There is one documented case for a patient with brain metastases derived from breast cancer (see link below). And I know another patient with brain metastases from breast cancer who also showed response and reduction of the number of brain metastases upon Boswellia treatment.

http://link.springer.com/article/10.1007%2Fs11060-006-9248-4

Hi Bernhard,

we conducted several research approaches to this issue- from my clinical experience I meant metastases /recidives of high grade gliomas. On the other hand we have a bright clinical experience within the use of boswellia and therefore could observe it`s significant life-quality improvement in patients suffering of high grade gliomas.

Brain stem glioma should be looked into if it is Diffuse intrinsic glioma of dorsal exophytic. In DIPG surgery is hardly possible treatment option. However, one should consider a biopsy to look into the nature of the lesion as  well as find some target-able molecular aberrations. Radiation forms the back bone of therapy. Conventional ratiocination radiation 60 Gy is well deliverable. Chemotherapy including Temozolomide has questionable role. However, even after radiation survival is dismal.