Glioblastoma Management Guidelines
Initial Management
- The standard of care for newly diagnosed glioblastoma includes maximal safe surgical resection followed by fractionated radiotherapy with concurrent and adjuvant temozolomide, as recommended by the American Society of Clinical Oncology 1, 2
- Gross total resection should be attempted whenever feasible to improve survival outcomes, according to the National Comprehensive Cancer Network 2, 3
- Biopsy is appropriate when resection is not possible or safe, as stated by the American Association of Neurological Surgeons 1
- For patients under 70 years with good performance status, standard fractionated radiotherapy is 60 Gy in 2-Gy fractions over 6 weeks, as recommended by the American Society for Radiation Oncology 1, 4
- Partial-brain radiation therapy is the standard approach rather than whole-brain radiation, according to the National Cancer Institute 5
- For elderly patients with good performance status, hypofractionated radiotherapy is recommended, as stated by the International Society for Geriatric Oncology 1, 2, 4
- Concurrent temozolomide and adjuvant temozolomide are recommended for patients under 70 years, as recommended by the European Association for Neuro-Oncology 1, 3
Molecular Testing
- MGMT promoter methylation testing is recommended to guide treatment decisions, particularly for elderly patients, as stated by the American Society of Clinical Oncology 3, 6
- IDH mutation status should be determined for proper classification and management, according to the World Health Organization 2, 6
Treatment of Recurrent Disease
- Surgical re-resection should be considered when feasible, as recommended by the American Association of Neurological Surgeons 2, 7
- Bevacizumab may improve progression-free survival but not overall survival, as stated by the National Comprehensive Cancer Network 1, 2
Prognostic Factors
- Favorable prognostic factors include younger age, good performance status, extent of resection, and MGMT promoter methylation, as recommended by the American Society of Clinical Oncology 1, 2, 3, 6, 9