Despite 20 years of clinical investigation of new surgical, radiotherapeutic, and chemotherapeutic approaches to the treatment of malignant gliomas, the prognosis for these patients remains dismal. New and innovative strategies are clearly required. The explosion of knowledge in molecular biology and our ever-increasing understanding of the molecular pathogenesis of neoplasia has opened up a number of new approaches to the treatment of brain tumors. The development and refinement of these strategies will require an unprecedented degree of collaboration and communication between the basic scientist, pharmaceutical/biotechnology companies, and clinical investigators. Most of all, the ability to identify novel and effective strategies will ultimately depend on the private clinician and his or her willingness to encourage patients with these tumors to participate in well-designed clinical trials that will test these novel strategies. With support from clinicians, and the close collaboration of investigators, it is hopeful that the next 20 years will bring significantly greater advances in the treatment of malignant gliomas than has ever been seen before.