Clinical Scenario

This protocol applies to newly diagnosed glioblastoma in patients older than 70 years who present with poor functional status and an MGMT promoter unmethylated tumor — a combination that significantly narrows which treatment strategies are appropriate.

Key Determinants in This Population

After maximal safe resection, treatment planning for this group is driven by the interplay of older age, reduced functional reserve, and MGMT unmethylated status. These factors together shift the risk-benefit calculus away from intensive combined approaches toward more targeted options. Patient care goals are also a central consideration.

Treatment Direction

Where eligibility allows, clinical trial enrolment is the preferred first step. For patients not eligible for a trial, a focused, abbreviated radiation strategy is the approach used for this MGMT unmethylated population — the complete regimen, decision criteria, and sequencing are detailed in the full protocol.

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.

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Treatment of Newly Diagnosed Glioblastoma in Patients Older Than 70 with Poor Functional Status and MGMT Unmethylated Tumor

References