Treatment of Newly Diagnosed Glioblastoma in Patients Older Than 70 with Good Functional Status and MGMT Unmethylated Promoter
Patients older than 70 years represent a distinct group in glioblastoma management. When functional status is preserved and the MGMT promoter is unmethylated, treatment decisions must carefully weigh age, performance, molecular profile, and patient care goals.
Clinical Scenario
This protocol applies to patients with a newly diagnosed glioblastoma who are older than 70 years, maintain good functional status, and carry an unmethylated MGMT promoter. Treatment decisions in this subgroup depend on the interplay of age, functional status, MGMT status, and individual patient care goals. Given the modest benefits of standard treatments in this setting, participation in clinical trials is highly recommended for patients with good performance status.
Surgical Approach (Partial Overview)
The initial step involves maximal safe resection of the tumor whenever it can be performed safely. When open surgical resection carries unacceptable risk — based on the patient's medical condition or the functional topography of the affected brain region — an alternative surgical procedure to obtain a histological and molecular diagnosis is considered. An additional minimally invasive option may be applicable in select cases where conventional open approaches are not optimal.
The full sequenced protocol — including all decision points beyond the surgical step — is available via the link below.
References
DOI: 10.1093/neuonc/noaf177
- Treatment decisions for glioblastoma after maximal safe resection depend on age, functional status, MGMT status, and patient care goals (Figure 8).
- Given the modest benefits of standard treatments, participation in clinical trials is highly recommended for patients with good performance status of any age.
- Nevertheless, the goal for glioblastoma surgery should be maximal safe resection of the enhancing and non-enhancing solid tumor whenever feasible.
- Whenever microsurgical resection is deemed to be too risky based on the patient's medical condition and/or the functional topography of the affected brain region, a stereotactic or open biopsy should be performed to obtain a histological and molecular diagnosis.
- For patients in whom conventional, open surgical approaches are not deemed optimal because of surgical risk, MRI-guided laser interstitial thermal therapy, a minimally invasive technique designed to ablate tumors, is sometimes an option.
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