Despite the growing number of elderly patients currently receiving radiotherapy little is known about the side-eects and outcome of radiation in this group of population. Several retrospective studies indicate that outcome of elderly patients with cancer regarding local control and survival is comparable to younger patients, with the exception of aged patients with rectal carcinoma and high grade glioma which is perhaps caused by the less aggressive combined modality treatment given to these patients. The incidence of primary malignant brain tumours and mortality amongst the elderly in developed countries have increased dramatically during the last 3 decades [1,2]. Some authors suggested that the gene pool of surviving 75 year old individuals in 1994 is dierent from the gene pool of surviving 75 year old individuals in 1900 indicating genetic factors are involved in the pathogenesis of primary brain tumours, the aggregate surviving gene pool of an ageing population cohort is important [3]. The relationship between age and outcome may, in part, re ect the greater proliferative potential of malignant glioma in older patients [4]. The role of radiotherapy, for patients with malignant gliomas, after whatever the type and extent of surgery, radical resection, partial resection or biopsy, is a recognised and unquestioned treatment, well established in randomised trials during the late 1970s [5,6]. Age, as well as histology, performance status scored by the Karnofsky performance scale (KPS) and extent of surgery, is one of the established prognostic factors [7±9]. When we evaluate the outcome of aged patients in clinical trials, we ®nd a speci®c problem in relation to age; as age of 65 years often represents a cut-o point for clinical trials. Furthermore, the majority of studies regard age as a split prognostic factor for analysis at the age of 50 years. An analysis of 1578 patients accrued from three successive Radiotherapy Oncology Group (RTOG) trials, with a top age limit of eligibility of 70 years, concluded that age under or over 50 years was the most important factor that distinguished patients with malignant glioma [7]. So elderly patients are not speci®cally approached. Most reports available consider the value of surgery and radiotherapy to be of questionable bene®t, although resection plus radiation doubles the mean length of postoperative survival [10]. Some studies have analysed the outcome of elderly patients with conventional treatment [11], pointing out that elderly patients with good performance status when treated with maximal resection and radiation have longer survival than those treated with a palliative intent with radiation therapy and biopsy, suggesting that intensive or radical treatment in this subset of population should be considered. Others reported that increasing age and poor neurological condition predict poor survival [12]. High grade gliomas are amongst the most devastating malignancies with few useful treatment options. Radiotherapy remains the most eective treatment modality in high grade glioma. Modem radiotherapy techniques to spare normal brain tissue when treating a tumour with a margin according to magnetic resonance imaging (MRI) image or computer tomography (CT) scan oers a survival bene®t, and in patients without extreme functional impairment the quality of life is good. Future studies in the treatment of central nervous system (CNS) tumours should include full evaluation of the patient functional status [13]. Patients with brain tumours have multiple functional disorders aecting mobility, communication, cognitive function and per-