[Optimization of the radiotherapy for the gliomas: hopes and research axis for the next future]

Glioma and particularly glioblastoma are tumours of very bad prognosis despite association of surgery and radiochemotherapy. This bad prognosis is mainly due to the local relapse after radiochemotherapy which occurs invariably despite constant technical progress in radiotherapy. This local recurrence is mainly due to the biologic intracellular and micro-environmental radioresistance of these tumours but also to a probable bad definition of the irradiated target. The two main axis of research aiming at optimizing the radiotherapy of these patients will be discussed: on one hand, the study of the biological pathways involved in the tumor radioresistance in order to highlight new targets of interest and to inhibit them by targeted drugs in combination with radiotherapy, and on the other hand, research in metabolic and functional imaging with the aim to define areas of most aggressive disease and even predictive zones of the site of relapse and thus of radioresistance, in order to integrate them in the radiotherapy treatment planning in prospective trials.