Predictive molecular biomarkers of radiosensitivity in adult glioma: a narrative review.

Gliomas are the most common malignant primary brain tumors in adults, yet their prognosis remains poor despite advances in treatment. Radiotherapy is a cornerstone of glioma management; however, its efficacy is often limited by tumor radioresistance. Understanding the molecular mechanisms underlying this resistance is critical for improving therapeutic outcomes. Recent research has identified key biomarkers and molecular pathways, including immune modulation, hypoxia, cell cycle regulation, apoptosis, and stress responses that influence tumor radiosensitivity and prognosis. This review explores predictive molecular biomarkers for radiosensitivity in gliomas, highlighting the latest advancements in preclinical studies and available clinical data, as well as their potential to inform future personalized radiotherapy strategies. Incorporating these biomarkers into clinical decision-making may facilitate patient stratification, guide combined modality approaches, and improve treatment precision and outcomes in glioma care.