All patients should be considered for radiation therapy after surgery (Sulman et al. 2017).

Fraction, dose and field is determined by age and performance status:

• Patients younger than 65 years should be considered for a fully fractionated course of highly conformal radiotherapy using intensity-modulated techniques, with concurrent chemotherapy as per the Stupp protocol.
• Patients aged between 65 and 70 years and older than 70 years, with a good performance status, should be considered for hypo-fractionated radiotherapy, with or without concurrent chemotherapy.
• MRI image fusion is recommended.

Timeframe for starting treatment

Radiation therapy should begin within six weeks after surgery.

Training and experience required of the appropriate specialists

Fellowship of the Royal Australian and New Zealand College of Radiologists or equivalent in radiation oncology with adequate training and experience treating brain tumours. Active involvement in multidisciplinary care is essential.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation treatment, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiation therapy (IGRT)
• dedicated CT planning
• access to MRI imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management system.