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Glioblastoma, newly diagnosed

Glioma & glioblastoma →

Surgery within days, six weeks of daily radiotherapy with temozolomide tablets, a month off, then six monthly cycles of temozolomide (with the option of a scalp device), and an MRI every two to three months.

01234567891011Months from diagnosis · solid bar = shortest typical duration, hatched = up to the longest · arrow = continues for yearsPhaseMRI and surgerySurgery and recovery · 1-2 wkRecoverySurgery and recovery · 3-5 wkChemoradiotherapyRadiotherapy · 6 wkBreakSystemic therapy · 4 wkAdjuvant temozolomideAfter surgery · 24 wkMRI surveillanceSurveillance · yearsIs MGMT methylated, and is the patient fit for the full course?decision 1Surgery and recoveryRadiotherapySystemic therapyAfter surgerySurveillance
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Typical sequence for Newly diagnosed disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

  1. 1. MRI and surgery
    weeks 0-2

    Contrast MRI then maximal safe resection (or biopsy) usually within 1-2 weeks; molecular testing for IDH, MGMT methylation and 1p/19q.

    Source
    Decision: Is MGMT methylated, and is the patient fit for the full course?
    • Fit: 6-week chemoradiotherapy then temozolomide
    • Older or frail: short-course radiotherapy, with temozolomide if MGMT is methylated
    • IDH-mutant (grade 2-3 glioma, not glioblastoma): a different, slower pathway including vorasidenib
  2. 2. Recovery
    weeks 1-6

    Wound healing and steroids tapering before radiotherapy starts, typically 3-5 weeks after surgery.

    Source
  3. 3. Chemoradiotherapy
    weeks 4-10

    60 Gy in 30 fractions over 6 weeks with daily temozolomide (Stupp protocol); a shorter 3-week course is used in older or frailer patients.

    Source
  4. 4. Break
    weeks 10-14

    Four weeks off treatment, then a baseline MRI.

    Source
  5. 5. Adjuvant temozolomide
    weeks 14-38

    Six 28-day cycles, tablets on days 1-5; tumour treating fields (EF-14) can be worn alongside.

    Source
  6. 6. MRI surveillance
    from week 38, continues for years

    MRI every 2-3 months; pseudoprogression in the first months can mimic recurrence.

    Source

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