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Purpose: Radiotherapy (RT) plays an integral role in the management of high-grade glioma (HGG). However, there is little information on the patterns of care in unselected Australian patients with HGG. Patient and Methods: This prospective cohort study collected information on patients with a diagnosis of HGG managed in Western Australia over a 25-month period from 2006 to 2008. RT treatment and survival data were analysed. Results: 86% of Western Australian patients with HGG were treated at the study site over this period. Of these, 80% were reviewed by a radiation oncologist with RT recommended in 88% of cases. One hundred eighty-seven patients proceeded to have RT, with most receiving 60 Gy in 30 fractions with limited field external beam radiotherapy (LFRT). Median survival from diagnosis was 13.6 months for all patients and 15.4 months for those planned for treatment with 60 Gy in 30 fractions. The median time from surgery to the start of RT was 41 days. Longer waiting times were not predictors of poor survival. Failure to receive all planned treatment (13% of patients) predicted for poor survival (hazard ratio 0.38). Conclusion: Dose and fractionation practices show concordance with published data and guidelines. Survival is also consistent with clinical trial data for patients planned for aggressive therapy. Nevertheless, a substantial number of patients are not suited to aggressive therapy or fail to complete planned therapy, and these patients have poor outcomes. Treatment delays did not affect survival outcomes but are confounded by earlier treatment of those unsuited to LFRT. [ABSTRACT FROM AUTHOR]