Clinical Scenario

This protocol addresses newly diagnosed glioblastoma in patients younger than 65–70 years who present with poor functional status and whose tumour carries an unmethylated MGMT promoter — a combination that substantially shapes regimen selection even at younger age.

Defining Characteristics

Newly diagnosed glioblastoma
Age younger than 65–70 years
Poor functional status
MGMT promoter unmethylated

After maximal safe resection, treatment decisions depend on age, functional status, MGMT methylation status, and individual patient care goals.

Treatment Approach

Despite the younger age bracket, poor functional status drives consideration of less intensive radiotherapy strategies. Radiotherapy — with or without concurrent chemotherapy — remains central, with the choice of regimen guided by the unmethylated MGMT profile and performance capacity. Eligibility for clinical trials is evaluated where available.

The complete regimen algorithm, including all options and selection criteria, is available in the full 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.

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Newly Diagnosed Glioblastoma with Poor Functional Status and MGMT Promoter Unmethylated (Age <65–70)

References