From the Guidelines
Glioblastoma treatment should involve a multimodal approach, including maximal safe surgical resection, concurrent radiation therapy, and chemotherapy with temozolomide, as this approach has been shown to improve median and 2-year survival in patients with glioblastoma 1.
Treatment Approach
The treatment of glioblastoma typically involves a combination of surgery, radiation therapy, and chemotherapy.
- Maximal safe surgical resection is often the initial step in treatment, with the goal of removing as much of the tumor as possible while preserving surrounding brain tissue.
- Concurrent radiation therapy and chemotherapy with temozolomide are then used to target any remaining tumor cells.
- After completing radiation, patients usually continue with maintenance temozolomide for 6-12 months.
Chemotherapy and Radiation
- Temozolomide is typically administered at a dose of 75 mg/m² daily during radiation, and then continued at a dose of 150-200 mg/m² for 5 days every 28-day cycle during the maintenance phase 1.
- Radiation therapy is usually administered in fractions of 2 Gy per day, 5 days a week, for a total dose of 60 Gy 1.
Considerations for Elderly Patients
- For elderly patients or those with MGMT promoter methylation, temozolomide alone may be considered as an alternative to concurrent radiation therapy and chemotherapy 1.
- Tumor treating fields (TTF) therapy may be added to maintenance temozolomide in some cases.
Prognosis and Monitoring
- Despite aggressive treatment, glioblastoma has a poor prognosis, with a median survival of 12-18 months 1.
- Regular MRI monitoring is essential during and after treatment to assess response and detect recurrence early.
- Symptoms of glioblastoma can vary based on tumor location, but commonly include headaches, seizures, cognitive changes, and focal neurological deficits.
From the Research
Glioblastoma Overview
- Glioblastoma is an aggressive and inevitably recurrent primary intra-axial brain tumor with a dismal prognosis 2.
- It is among the most difficult cancers to treat, and 5-year survival rates remain low 3.
- Glioblastoma affects approximately 250,000 new patients per year worldwide 3.
Treatment Options
- The current mainstay of treatment involves maximally safe surgical resection followed by radiotherapy over a 6-week period with concomitant temozolomide chemotherapy followed by temozolomide maintenance 2.
- Standard therapies for glioblastoma include surgical resection, radiation therapy, and systemic chemotherapy 3.
- Therapeutic options for newly diagnosed glioblastoma include temozolomide, lomustine, and tumor treating fields (TTF) 3.
- Bevacizumab, temozolomide, and radiotherapy are three therapeutic methods, and the combination of them is still under investigation 4.
Efficacy of Treatment Options
- Adding bevacizumab to standard therapy improved progression-free survival (PFS) in patients with newly diagnosed glioblastoma 4.
- Overall survival (OS) showed modest improvements, with 2-year OS rates of 39% vs. 20% favoring bevacizumab 4.
- The combination of dose-dense temozolomide and bevacizumab is of interest for glioblastoma patients experiencing first relapse 5.
- Maximal safe resection is the first intervention for management of glioblastoma and has been associated with prolonged survival in numerous retrospective studies 6.