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Radiotherapy is a key treatment modality in the management of several primary brain tumours. For patients with recurrent disease, however, optimal management strategies are often less well defined. In particular, for patients with recurrent glioblastoma, there is no standard of care. Options may include surgery, systemic therapy, re-irradiation or best supportive care. Treatment decisions are made on an individual patient basis based on performance status, time to recurrence from initial treatment, volume and site of recurrence and the molecular features of the disease. Re-irradiation is an accepted treatment option for selected patients with recurrent glioblastoma, although the optimal re-irradiation strategy is unknown. Understandably concerns exist with respect to the risk of excessive normal tissue toxicity from irradiating brain that has already received high dose irradiation. The development of radionecrosis is a toxicity of particular concern. Various approaches have been adopted in the re-irradiation setting in terms of target volume definition, treatment modality, dose and fractionation, organ at risk constraints and use of concurrent systemic therapies. While encouraging results have been demonstrated from several strategies, much of the evidence regarding re-irradiation is considered of lower quality and there is a paucity of quality of life data. With a focus on recurrent glioblastoma, but also with reference to other brain tumours, the who, what, where, when and how of brain re-irradiation will be discussed.