This protocol applies to patients with newly diagnosed glioblastoma who are younger than 65–70 years but present with poor functional status and confirmed MGMT promoter methylation. Treatment decisions in this population depend on age, functional status, MGMT methylation status, and individual patient care goals.
The primary goal is maximal safe surgical resection of the tumor whenever feasible. When open resection carries excessive risk — due to the patient's medical condition or the tumor's location in a functionally critical brain region — a biopsy approach is used instead to obtain the histological and molecular diagnosis needed to guide further management. Additional options exist for specific situations; the complete treatment algorithm follows in the structured regimen.
Treatment decisions for glioblastoma after maximal safe resection depend on age, functional status, MGMT status, and patient care goals (Figure 8).
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.
DOI: 10.1093/neuonc/noaf177
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