What are the current guidelines for the management of glioblastoma multiforme in terms of surgical intervention and adjuvant therapies?

For newly diagnosed glioblastoma multiforme (grade 4 glioma), surgical resection should be considered to obtain a histological and molecular diagnosis and to remove as much of the tumour as safely possible, after discussion with a multidisciplinary team and the patient, their relatives, and carers ¹.

If surgical resection is not appropriate, a biopsy should be considered to obtain a diagnosis ¹.

In cases where surgery is performed, radiotherapy using 60 Gy in 30 fractions with concomitant temozolomide, followed by up to 6 cycles of adjuvant temozolomide, is recommended for patients aged around 70 or under with good performance status and who have had maximal safe resection or biopsy ¹.

For patients aged around 70 or over with good performance status and MGMT methylation, radiotherapy with 40 Gy in 15 fractions plus concomitant and up to 12 cycles of adjuvant temozolomide is advised ¹.

In patients aged around 70 or over without MGMT methylation or with unknown methylation status, consider the same radiotherapy regimen or best supportive care if appropriate ¹.