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This randomized clinical trial evaluates a novel radiotherapy approach—modified target delineation guided by multimodal magnetic resonance imaging (MRI) and white matter tractography combined with moderately hypofractionated simultaneous boost intensity-modulated radiotherapy (HSIB-IMRT)—in high-grade glioma (HGG). The study found that this technique significantly reduces clinical target volumes without compromising progression-free survival (PFS), overall survival (OS), or increasing recurrence outside irradiated areas. Safety profiles were comparable to standard treatment, underscoring the potential for personalized, volume-sparing radiotherapy to mitigate neurotoxicity in HGG management.
