Currently the standard of care, which is now more than thirty years old, is radiation following diagnosis. Radiation Treatment begins immediately following diagnosis. Radiation oncologist plans radiation treatment which may include the standard 54 gry of radiation given over 30 doses, or an abbreviated course of radiation of 29 gry. Photon radiation and Proton radiation have been found equally effective. Care should be given to know whether the clinical trial a patient may seek to enter following radiation will accept any protocol of radiation with less than 54 gry. If so, fractionated radiation or photon or proton radiation with radiation sensitizers, or delivery of clinical trial drugs during radiation are available to try instead of the standard of care radiation. In some cases the pons will appear smaller or the tumor less dense after radiation.  Steroids to Control Inflammation In the Best Practice for Newly Diagnosed, steroids are also discussed. Traditionally, steroids, specifically dexamethasone, is given at diagnosis with the goal of stabilizing the neurological symptoms until biopsy or radiation begins. However, complications due to long term and escalating dose steroid use should be avoided whenever possible. The patient family should be given information to assist in understanding the benefits of pulse dosing steroids and weaning off steroids when tolerated. Steroids stabilize the blood brain barrier and can affect tissue penetration of systemic therapies. Additionally, dexamethasone is associated with worse overall survival.  Shunts, Ommayas and apparatus to control CSF buildup On occasion, in about 10% of all DMG DIPG patients, hydrocephalus occurs requiring relief of the buildup of cerebral spinal fluid (CSF). This may be managed with medication or installation of an Ommaya catheter, Ventricular Assisted Devise, or ventricular shunt. Some clinical trials exclude patients following the installation of certain apparatus reducing hydrocephalus. Therefore, the DIPG DMG National Brain Tumor Board recommends using the tumor board to consult with providers on the placement of such apparatus, the timing with respect to clinical trials of interest for the patient and for alternatives to shunts and steroids. Clinical Trials and Protocols Beyond these protocols more common in DIPG DMG treatment, Phase I or Phase II clinical trials are offered to evaluate the safety (in Phase I trials) or the efficacy (in Phase II trials) of proposed treatments. Clinical trials are listed at clinicaltrials.gov and routinely updated as to the status of recruiting, actively enrolling, or enrollment completed. To date, there is no cure for DIPG DMG. There is not one clinical trial that is proving successful in a majority of patients entering the trial. Yet, a small percentage of patients are outliving the two years outside life expectancy, many following enrollments in one or another clinical trial. New DIPG research may provide the key to improved personalized treatment options. It may help discover why one trial is working better for one patient and another trial works better for another patient. The DIPG DMG National Brain Tumor Board will to review clinical trial and compassionate protocol options with providers in order to shed light on best practices, by consensus, and trial recommendations for patient care.