• EGFRvIII: EGFRvIII is a mutant, tumour-only version of the EGFR receptor found in about a third of glioblastomas.
• Necrosis: Messy, uncontrolled cell death, where the cell bursts and spills its contents.
• Extent of resection (RANO resect classes): How much of a brain tumour the surgeon removes, measured on an MRI scan soon after the operation.
• Accelerated approval: FDA approval based on early evidence (like tumour shrinkage) on condition that a confirmatory trial follows.
• Hot vs cold tumours: 'Hot' tumours are full of immune cells and respond to immunotherapy; 'cold' tumours have kept the immune system out.
• Metabolic theory of cancer: from Warburg to oncometabolites: Otto Warburg noticed a century ago that cancer cells ferment glucose even when oxygen is plentiful and concluded that damaged respiration causes cancer.
• Bioelectric theory of cancer (Levin): Cells hold a voltage across their membranes, and tissues share these voltages as patterns that guide growth and regeneration.
• MGMT promoter methylation: A chemical switch that turns off a DNA-repair gene.
• H3 K27M (diffuse midline glioma): A single change in a histone protein that defines diffuse midline glioma, the childhood brain tumour with the fewest treatment options, and now the target of the first approved drug for it.
• Cancer stem cell theory and phenotypic plasticity: The idea that a tumour is organised like a tissue, with a small pool of stem-like cells that renew it and a bulk that cannot, so killing the bulk shrinks the tumour but the stem-like cells regrow it.

Diagnosis: MRI with contrast; maximal safe resection with 5-ALA and intraoperative mapping, with early postoperative MRI to measure the extent of resection; integrated histo-molecular diagnosis with methylation classification where available.

Glioblastoma, newly diagnosed: Radiotherapy 60 Gy in 30 fractions with concurrent and 6 cycles adjuvant temozolomide; from age 65, short-course radiotherapy (40 Gy in 15 fractions) with temozolomide (CCTG CE.6); for older patients unfit for combined treatment, temozolomide alone or hypofractionated radiotherapy alone, chosen by MGMT status (Nordic, NOA-08); TTFields with maintenance temozolomide; trials for MGMT-unmethylated patients.

Biomarker results to ask for: IDH1/2, 1p/19q codeletion, MGMT methylation, H3K27M, EGFR amplification, Methylation class, IDH1/2 mutation (vorasidenib eligibility), MGMT promoter methylation (temozolomide benefit), H3 K27M (dordaviprone eligibility), BRAF fusion / V600E (tovorafenib, dabrafenib-trametinib), TERT promoter, EGFR amplification, +7/−10 (molecular glioblastoma), CDKN2A/B homozygous deletion (grade 4 astrocytoma), DNA methylation class (Heidelberg classifier), NTRK/ALK/ROS1 fusions (infant gliomas), TMB / mismatch repair (rare hypermutant, IO-responsive).

Scans and tests linked to this cancer: MRI, PET (positron emission tomography), PET/CT, DNA methylation profiling, Fluorescence-guided surgery, Intraoperative fluorescence and Cerenkov imaging systems (SPY, Firefly, LumiSystem, LightPath).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• Glioblastoma: Resection → RT + temozolomide → TTFields; lomustine/bevacizumab at relapse. (Fluorescence-guided surgery, IMRT / IGRT (modern external beam), Optune / Optune Pax (TTFields))
• IDH-mutant grade 2: Resection → vorasidenib or observation; RT/PCV for high-risk. (Vorasidenib)
• Glioblastoma, recurrent: Re-resection or LITT if feasible; lomustine; bevacizumab for oedema/steroid sparing; re-irradiation; clinical trial (CAR-T, FUS-BBB, vaccines) strongly preferred. (Lomustine (CCNU), Bevacizumab (glioblastoma use), Laser interstitial thermal therapy (LITT), CAR-T for glioma (IL13Rα2, GD2, EGFRvIII, multi-target), Focused-ultrasound blood-brain barrier opening, SBRT / SABR (stereotactic radiotherapy))
• IDH-mutant grade 2 glioma: Maximal resection; vorasidenib for residual/recurrent disease (INDIGO); radiotherapy plus PCV or temozolomide for high-risk or progressive disease. (Vorasidenib, INDIGO)
• Oligodendroglioma grade 3 / astrocytoma grade 3: Radiotherapy plus PCV (RTOG 9402, EORTC 26951) or temozolomide (CATNON). (Temozolomide, IMRT / IGRT (modern external beam))
• H3 K27M diffuse midline glioma: Radiotherapy; dordaviprone at progression (2025); GD2 CAR-T and ONC201 first-line trials. (Dordaviprone, CAR-T for glioma (IL13Rα2, GD2, EGFRvIII, multi-target))
• Paediatric low-grade glioma: Resection where safe; chemotherapy (carboplatin/vincristine) or tovorafenib / dabrafenib-trametinib for BRAF-altered relapsed disease; avoid radiation in young children. (Tovorafenib)

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.