Abstract: To retrospectively analyze the toxicity, short-term effects, and survival rate of patients with recurrent high-grade gliomas after re-irradiation with intensity-modulated radiation therapy ( IMRT ) with or without chemotherapy. Methods: From January 2007 to December 2009, 19 patients with recurrent gliomas were re-irradiated with conventional fractionated IMRT. The interval between radiation courses was 9-156 months ( median: 32 months ). The radiation dose was 40–60 Gy, 17–30 fx, 28–45 d ( median: 48 Gy, 24 fx, 35 d ). The biologically effective dose was calculated using the linear quadratic model. Radiation toxicity and short-term efficacy were recorded. The overall survival rate, relapse-free survival rate, and radiation necrosis–free survival rate was calculated. Results: The median biological equivalent dose was 58 Gy ( 48-72 Gy ) in this group. Grades I and II of acute digestive tract side effects, headache and aggravation of neurologic dysfunction, were observed, which were relieved with symptomatic treatment. Toxicity of more than grade III was not found. Five cases with radiation necrosis were found. Among the 19 cases, 3 cases had partial remission, 13 cases had stable disease, and 3 cases had progressive disease. Up to 5 cases had increased Karnovsky performance status, 4 cases had declined Karnovsky performance status, and 10 cases hat no change. The 1- and 2-year overall survival rates were 62.4% and 34.0%. The median survival time of the anaplastic gliomas and glioblastomas were 11 and 10 months, respectively. The 1- and 2-year relapsed-free survival rates were 45.6% and 26.1%. The 1- and 2-year radiation necrosis-free rates were 68.8% and 55.0%. Conclusion: The preliminary results demonstrate that re-irradiation with IMRT and modest dose (median BEDα/β = 10 = 58 Gy ) with or without chemotherapy for recurrent HGG appear to be effective and safe. With the limited number of patients in this group, re-irradiation could be used for treating recurrent gliomas with caution, which deserves further study.