Treatment of Newly Diagnosed Glioblastoma in Patients Under 65–70 Years with Poor Functional Status and MGMT Promoter Unmethylated

Clinical Scenario

This protocol applies to patients with newly diagnosed glioblastoma who are younger than 65–70 years yet present with poor functional status and an MGMT promoter‑unmethylated tumour. In this population, treatment decisions hinge on the interplay of age, functional status, MGMT methylation status, and patient care goals.

Newly diagnosed Age < 65–70 yrs Poor functional status MGMT unmethylated

Surgical Management — Overview

Initial management centres on achieving maximal safe resection of the tumour whenever the patient’s condition and tumour location allow it. When open surgical resection carries too high a risk, a targeted biopsy approach is used to secure the histological and molecular diagnosis needed to guide further care. For select patients, a minimally invasive alternative to conventional open surgery may also be considered — the full structured protocol details what follows from there.

Instant Access to Structured Evidence-Based Regimens

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).

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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