Treatment of Newly Diagnosed Glioblastoma in Patients Older Than 70 With Poor Functional Status and MGMT Unmethylated Promoter
Clinical Scenario
This protocol addresses patients who present with a new diagnosis of glioblastoma, are older than 70 years of age, have poor functional status, and whose tumour carries an unmethylated MGMT promoter. Treatment decisions in this sub-population are shaped by the interplay of age, performance level, and MGMT methylation status.
Age >70 years
Poor functional status
MGMT unmethylated
Newly diagnosed
Surgical Approach — Overview
The initial management centres on a surgical strategy tailored to each patient's condition and tumour location. The goal is maximal safe resection when feasible; when open resection carries too high a risk, less invasive approaches are considered to secure a histological and molecular diagnosis. A minimally invasive technique is sometimes an option for select patients where conventional surgery is not optimal.
Full regimen detail, subsequent treatment steps, and individualised decision guidance are available in the complete protocol 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).
- Treatment regimens for newly diagnosed glioblastoma patients older than 65–70 years involve standard radiochemotherapy but shortened regimens for frailer patients may include hypofractionated radiation (eg, 40 Gy in 15 fractions) with temozolomide, hypofractionated radiation alone for patients with MGMT unmethylated glioblastoma, or temozolomide alone for patients with MGMT methylated glioblastoma.
- 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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