For patients with glioma, if surgery is just to cut the grass, then post-operative radiotherapy is to remove the root of the tumor. So, is it better to do radiotherapy or chemotherapy after surgery? When is the best time to do it? Currently, the standard treatment model for glioma is “surgery – temozolomide synchronized radiotherapy – temozolomide adjuvant chemotherapy”. This comprehensive treatment model requires close collaboration between neurosurgeons, radiologists and medical oncologists. Radiotherapy in this context generally refers to conventional radiotherapy or conformal intensity-modulated radiotherapy, and does not include such irradiation modalities as X-knife or Gamma Knife or Proton Knife. Through evidence-based medical research, radiotherapy is generally considered appropriate for patients with the following conditions: 1. Patients with grade II glioma under the age of 45 years who have clear residuals on postoperative MRI; 2. Patients with grade II glioma over the age of 45 years; 3. Patients with grade III and IV glioma. In the case of simple grade I astrocytoma for, or grade II astrocytoma but younger than 45 years old, patients with surgical resection of the entire tumor do not require radiotherapy and can be closely reviewed and monitored. For patients who need radiotherapy, it is recommended to start treatment as soon as possible about 2 to 4 weeks after surgery, but postoperative treatment of malignant glioma with X-knife or gamma knife or proton knife is not recommended. This is because this type of treatment does not have much impact on the postoperative survival rate of glioma patients, and radiation necrosis of the treated area may also occur after six months to a year of gamma knife or X-knife treatment, or even after two years. That is, cerebral edema around the radiation area, the patient’s headache and vomiting worsen, and even symptoms such as epilepsy, drowsiness, hemiplegia and aphasia unable to walk. The symptoms often worsen with time, and the radionecrosis lesion gradually expands, which also makes it difficult for doctors to distinguish whether it is tumor recurrence or real radionecrosis. Especially after normal radiotherapy or conformal intensity modulated radiotherapy, and then X-knife or gamma knife or proton knife, most patients will have radiation necrosis of brain tissue. Moreover, this radiation damage is difficult to treat, basically incurable, and in severe cases may be disabling and fatal. Although radionecrosis is not completely prevented after standard radiotherapy, the incidence is very low. Some patients also hope that they can kill cancer cells by not having an incision. However, some patients’ scalp is so irradiated that it becomes thin and brittle, and if surgery is performed at this time, the wound will not heal easily and the later recovery will not be good. Therefore, it is also not recommended to go for radiotherapy before surgery. After irradiation, the tumor will react very much, the nerves and blood vessels will adhere to each other, the surrounding blood vessels will harden, and even radioactive necrosis will occur, then even if surgery is performed, the resection area will have to be larger than the entire irradiation area to be clean, or even impossible to operate at all. Therefore, if a patient has undergone such radiation therapy, he or she should wait at least two years before surgery is appropriate. In fact, only after surgery for low-grade glioma, when the residual lesions are very small, can be cleared with the aid of Gamma Knife, but in all other cases it is not suitable. For chemotherapy, the commonly used drug is temozolomide, which will affect the absorption of the drug when taken after meals, so it is required to be taken on an empty stomach. However, it is easy to cause gastrointestinal reactions such as nausea and vomiting on an empty stomach, so it is best to take an antiemetic once half an hour before taking chemotherapy drugs to effectively relieve the gastrointestinal reactions caused by chemotherapy drugs. For patients with high-grade glioma, postoperative chemotherapy is an important tool to reduce recurrence, significantly prolong survival and improve quality of life. If financial conditions allow, chemotherapy should basically be maintained all the time, during which it can be suspended for a period of time with the permission of the doctor, but after that it should be resumed and continued all the time. For example, in glioblastoma, radiotherapy should be given as early as possible after surgery, and small doses of temozolomide should be given at the same time as radiotherapy (i.e., radiotherapy-chemotherapy synchronization), and temozolomide chemotherapy should be continued one month after radiotherapy is finished, when the dose should be increased. This chemotherapy drug (temozolomide) is usually taken after radiotherapy for 5 days in a row and stopped for 23 days, which is a cycle. Then start taking it again for 5 days in a row and stop for 23 days …… all the way to 6 consecutive cycles. The specific dosage of these medications should strictly follow the doctor’s instructions. For low-grade glioma, it is divided into two cases. If it is a high-risk, low-grade glioma, it needs chemotherapy; if it is a low-risk, low-grade glioma, it does not need chemotherapy. Especially for patients with oligodendroglioma, chemotherapy is more effective and can significantly prolong the survival and recurrence time. For grade 1 glioma, chemotherapy is generally not required. Since chemotherapy drugs affect liver and kidney function and blood, liver and kidney function and blood routine should be rechecked once a month during chemotherapy. If there is any abnormality, we need to find the doctor for adjustment in time. Finally, the effect of radiotherapy should be judged by the review. If the review film shows that the lesions have expanded, it means that radiotherapy is not effective; if the review film shows that the original residual small lesions gradually shrink or even disappear, it means that the effect is better; if the time of recurrence is prolonged, it also means that radiotherapy is effective. But what if the tumor recurs even after comprehensive treatment (in fact, most of the high-grade gliomas recur)? In fact, the main purpose of comprehensive treatment is to suppress “residual forces”, prevent “new forces” and delay recurrence, but if recurrence is rapid, it means that the treatment is not sensitive. In this case, if the health condition is good and the tumor is limited and not in the functional area, then reoperation is still the most effective treatment. Of course, the risk of secondary surgery is slightly higher than the first one, such as a 5% increase in the incidence of infection, and the cost of treatment should be increased, and it cannot be cured, so patients and families need to consider carefully.