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OBJECTIVE To analyze the therapeutic effects and side effects of intensity-modulated radiotherapy (IMRT) with different fractionated doses in treating astrocytoma. METHODS During a period from October 2001 to December 2006, 58 patients with astrocytoma were treated using IMRT. Based on the World Health Organization (WHO) classification, 32 of the 58 cases were grade-II, 20 grade-III and 6 grade-IV (glioblastoma multiforme, GBM). Thirty-two of the 58 patients (3 with grade IV, 11 with grade III, and the other 18 with grade II who were over 40 years) were treated with hyperfractionated IMRT (Hyper Fr IMRT), and the other 26 patients were treated with standard fractionated IMRT (St Fr IMRT).RESULTS The 1-, 3- and 5-year overall survival (OS) rates were respectively 86%, 52%, and 45%, and the 1-, 3- and 5-year progression-free survival (PFS) rates were respectively 77%, 38%, and 25%. Using an analytical hierarchy process it was shown that concerning the patients with grade II astrocytoma classified based on WHO grading, the therapeutic effect was much better in the group of Hyper Fr IMRT than in the St Fr IMRT group. There was no statistical significance of the differences in the OS and PFS rates between the 2 groups (P = 0.049 and P = 0.006). The OS and PFS rates of the patients with grade-III astrocytoma were both higher in the group with Hyper Fr IMRT than in the St Fr IMRT group. However, there was no statistical significance of the differences between the 2 groups. Advanced RTOG grade-III (radiation therapy oncology group, RTOG) neurotoxicity occurred only in 1 of the cases. CONCLUSION Compared with the St Fr IMRT, the Hyper Fr IMRT may help to prolong the survival of patients with astrocytoma.