This protocol applies to adults with newly diagnosed glioblastoma who are younger than 65–70 years of age, maintain good functional status, and whose tumour carries an unmethylated MGMT promoter. Treatment decisions in this setting are shaped by age, functional status, MGMT methylation status, and patient care goals following maximal safe resection — each of which influences which approaches are appropriate.
Clinical trial enrollment is strongly preferred for patients with good performance status. Where standard-of-care applies, a radiotherapy-based regimen is central — the MGMT unmethylated status carries specific implications for how the chemotherapy component is used alongside radiotherapy, and for which patients certain combinations are or are not included.
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.
For patients with good performance status, standard-of-care includes radiotherapy (60 Gy over 6 weeks) with concurrent temozolomide (75 mg/m2/day × 6 weeks), followed by maintenance temozolomide (150–200 mg/m2/day × 5 days for six 28-day cycles).
For patients with newly diagnosed MGMT promoter unmethylated glioblastoma, radiotherapy alone can be considered especially if participating in clinical trials omitting temozolomide.
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