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Glioblastoma

Last edited: 4/14/2026

Overview

Glioblastoma (GBM) is an aggressive and highly malignant brain tumor characterized by rapid growth and poor prognosis, with a median survival of approximately 12-15 months despite current treatment modalities 1.

Diagnosis

  • Imaging: MRI with contrast is essential for diagnosis, showing typical features like necrosis and peritumoral edema 1.
  • Histopathology: Confirmation through biopsy or resection with identification of microvascular proliferation and/or necrosis consistent with WHO grade IV 127.
  • Grading: GBM is definitively graded as WHO grade IV 127.

    • Management

  • First-line Treatment: Surgical resection followed by concurrent radiation therapy (RT) and temozolomide (TMZ) chemotherapy 928.
  • Radiation Therapy: Conventional or hypofractionated radiotherapy (HFRT) is used, with HFRT showing comparable survival outcomes 9.
  • Chemotherapy: Temozolomide (75 mg/m2 daily) during and after RT 928.
  • Adjunctive Therapies:
    • - Oncolytic Viruses: G47Δ and DNX-2401 show efficacy and safety profiles in clinical trials 613. - Immunotherapies: Peptide vaccines targeting GBM are under investigation 2. - Local Drug Delivery: Still considered promising for enhancing drug efficacy 10.

    Special Populations

  • Elderly Patients: Hypofractionated radiotherapy with concurrent and adjuvant TMZ improves survival 928.
  • Pediatrics: Awake craniotomy for resection can be performed safely in children, though rare 33.
  • Comorbidities: No specific guidelines provided in abstracts; management tailored to individual patient needs 12.

    • Key Recommendations

  • Surgical Resection Followed by Concurrent RT and TMZ: Essential for newly diagnosed GBM patients to improve survival (Evidence: Strong 928).
  • Consider Hypofractionated Radiotherapy in Elderly Patients: Offers comparable survival benefits to conventional RT (Evidence: Moderate 9).
  • Evaluate Novel Therapies: Oncolytic viruses and immunotherapies like peptide vaccines show promise but require further validation (Evidence: Weak 62).

    • References

    1 Yu SP. Editorial for the Special Issue "Glioblastoma: What Do We Know?". Cells 2026. link 2 Mohammadi M, Razmara J, Hadizadeh M, Parvizpour S, Shahir Shamsir M. Peptide vaccine design against glioblastoma by applying immunoinformatics approach. International immunopharmacology 2024. link 3 . F3 Regulates Radiation Therapy-Induced Remodeling and Resistance in Glioblastoma. Cancer discovery 2023. link 4 . Rhythmic Ca2+ Communication Promotes Glioma Cell Proliferation. Cancer discovery 2023. link 5 . Phenotype Switching in Glioblastoma Promotes Therapy Escape. Cancer discovery 2023. link 6 . The Oncolytic Virus G47Δ Shows Efficacy and Safety in Glioblastoma. Cancer discovery 2022. link 7 . EGFR Mutations in GBM Alter Ligand Binding and Subsequent Dimerization. Cancer discovery 2022. link 8 . Neuronal Mechanisms Drive Whole Brain Invasion in Glioblastoma. Cancer discovery 2022. link 9 Guo L, Li X, Chen Y, Liu R, Ren C, Du S. The efficacy of hypofractionated radiotherapy (HFRT) with concurrent and adjuvant temozolomide in newly diagnosed glioblastoma: A meta-analysis. Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique 2021. link 10 Bastiancich C, Bozzato E, Henley I, Newland B. Does local drug delivery still hold therapeutic promise for brain cancer? A systematic review. Journal of controlled release : official journal of the Controlled Release Society 2021. link 11 Herrlinger U. News on the horizon in glioblastoma therapy. ESMO open 2020. link 12 . Modified Poliovirus Tested in Glioblastoma. Cancer discovery 2018. link 13 . The Oncolytic Adenovirus DNX-2401 Has Antitumor Activity in Glioblastoma. Cancer discovery 2018. link 14 . With GBM, T Cells May Be Stuck in Bone Marrow. Cancer discovery 2018. link 15 Mazerand E, Le Renard M, Hue S, Lemée JM, Klinger E, Menei P. Intraoperative Subcortical Electrical Mapping of the Optic Tract in Awake Surgery Using a Virtual Reality Headset. World neurosurgery 2017. link 16 Lundemann M, Costa JC, Law I, Engelholm SA, Muhic A, Poulsen HS et al.. Patterns of failure for patients with glioblastoma following O-(2-. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 2017. [link 17 Kuchinad KE, Strowd R, Evans A, Riley WA, Smith TJ. End of life care for glioblastoma patients at a large academic cancer center. Journal of neuro-oncology 2017. link 18 Kneepkens E, Fernandes A, Nicolay K, Grüll H. Iron(III)-Based Magnetic Resonance-Imageable Liposomal T1 Contrast Agent for Monitoring Temperature-Induced Image-Guided Drug Delivery. Investigative radiology 2016. link 19 Pinggera D, Kerschbaumer J, Innerhofer N, Woehrer A, Freyschlag CF, Thomé C. Disseminated Intravascular Coagulation in Secondary Glioblastoma due to Excessive Intraoperative Bleeding: Case Report and Review of the Literature. World neurosurgery 2016. link 20 Ivanishvili Z, Pujara S, Honey CM, Chang S, Honey CR. Stereotactic mesencephalotomy for palliative care pain control: A case report, literature review and plea to rediscover this operation. British journal of neurosurgery 2016. link 21 Guo M, Luo H, Samii A, Etminan M. The Risk of Glioblastoma with TNF Inhibitors. Pharmacotherapy 2016. link 22 Wolbers JG. Novel strategies in glioblastoma surgery aim at safe, supra-maximum resection in conjunction with local therapies. Chinese journal of cancer 2014. link 23 Barajas RF, Hess CP, Phillips JJ, Von Morze CJ, Yu JP, Chang SM et al.. Super-resolution track density imaging of glioblastoma: histopathologic correlation. AJNR. American journal of neuroradiology 2013. link 24 James NS, Ohulchanskyy TY, Chen Y, Joshi P, Zheng X, Goswami LN et al.. Comparative tumor imaging and PDT Efficacy of HPPH conjugated in the mono- and di-forms to various polymethine cyanine dyes: part - 2. Theranostics 2013. link 25 Fu J, Ngo A, Shin K, Bruera E. Botulinum toxin injection and phenol nerve block for reduction of end-of-life pain. Journal of palliative medicine 2013. link 26 Colen CB, Allcut E. Quality of life and outcomes in glioblastoma management. Neurosurgery clinics of North America 2012. link 27 Gupta T, Nair V, Epari S, Pietsch T, Jalali R. Concordance between local, institutional, and central pathology review in glioblastoma: implications for research and practice: a pilot study. Neurology India 2012. link 28 Barker CA, Chang M, Chou JF, Zhang Z, Beal K, Gutin PH et al.. Radiotherapy and concomitant temozolomide may improve survival of elderly patients with glioblastoma. Journal of neuro-oncology 2012. link 29 Whittle IR, Stavrinos N, Akil H, Yau Y, Lewis SC. Assessment of physiological parameters within glioblastomas in awake patients: a prospective clinical study. British journal of neurosurgery 2010. link 30 Laigle-Donadey F, Figarella-Branger D, Chinot O, Taillandier L, Cartalat-Carel S, Honnorat J et al.. Up-front temozolomide in elderly patients with glioblastoma. Journal of neuro-oncology 2010. link 31 Minniti G, De Sanctis V, Muni R, Rasio D, Lanzetta G, Bozzao A et al.. Hypofractionated radiotherapy followed by adjuvant chemotherapy with temozolomide in elderly patients with glioblastoma. Journal of neuro-oncology 2009. link 32 Kwon D, Choi IH. Hydrogen peroxide upregulates TNF-related apoptosis-inducing ligand (TRAIL) expression in human astroglial cells, and augments apoptosis of T cells. Yonsei medical journal 2006. link 33 Klimek M, Verbrugge SJ, Roubos S, van der Most E, Vincent AJ, Klein J. Awake craniotomy for glioblastoma in a 9-year-old child. Anaesthesia 2004. link 34 Pál E, Gömöri E E, Gáti I. Neurofibromatosis and glioblastoma in a case of multiple sclerosis. European journal of neurology 2001. link 35 Greif J, Horovitz M, Marmor S. Pleuropulmonary metastasis from an intracranial glioblastoma. Lung cancer (Amsterdam, Netherlands) 1998. link00029-4) 36 Gratsa A, Rooprai HK, Rogers JP, Martin KK, Pilkington GJ. Correlation of expression of NCAM and GD3 ganglioside to motile behaviour in neoplastic glia. Anticancer research 1997. link 37 Bishayee S. A novel 200 kDa plasma membrane glycoprotein with high basal tyrosine kinase activity in tumour cells. Indian journal of biochemistry & biophysics 1997. link 38 Arcuri C, Tardy M, Rolland B, Armellini R, Menghini AR, Bocchini V. Glutamine synthetase gene expression in a glioblastoma cell-line of clonal origin: regulation by dexamethasone and dibutyryl cyclic AMP. Neurochemical research 1995. link 39 da Cruz LA, Cruz TF, Moscarello MA. A glycoprotein expressed by human fibrous astrocytes is a hyaluronate-binding protein and a member of the CD44 family. Cell adhesion and communication 1993. link 40 Rutz HP, de Tribolet N, Calmes JM, Chapuis G. Long-time survival of a patient with glioblastoma and Turcot's syndrome. Case report. Journal of neurosurgery 1991. link 41 Kishikawa M, Tsuda N, Fujii H, Nishimori I, Yokoyama H, Kihara M. Glioblastoma with sarcomatous component associated with myxoid change. A histochemical, immunohistochemical and electron microscopic study. Acta neuropathologica 1986. link 42 Breteau N, Destembert B, Sabattier R, Schlienger M. An interim assessment of the experience of fast neutron boost in glioblastomas, rectal and bronchus carcinomas in Orleans. Strahlentherapie 1985. link 43 Newman RP, Schaefer EJ, Thomas CB, Oldfield EH. Abetalipoproteinemia and metastatic spinal cord glioblastoma. Archives of neurology 1984. link 44 Ederli A, Lo Russo F, Vesentini G. Glioblastoma of the brainstem associated with Hodgkin lymphoma. Italian journal of neurological sciences 1983. link

    Original source

    1. [1]
      Editorial for the Special Issue "Glioblastoma: What Do We Know?". — Yu SP Cells (2026)
    2. [2]
      Peptide vaccine design against glioblastoma by applying immunoinformatics approach. — Mohammadi M, Razmara J, Hadizadeh M, Parvizpour S, Shahir Shamsir M International immunopharmacology (2024)
    3. [3]
      F3 Regulates Radiation Therapy-Induced Remodeling and Resistance in Glioblastoma. Cancer discovery (2023)
    4. [4]
      Rhythmic Ca2+ Communication Promotes Glioma Cell Proliferation. Cancer discovery (2023)
    5. [5]
      Phenotype Switching in Glioblastoma Promotes Therapy Escape. Cancer discovery (2023)
    6. [6]
      The Oncolytic Virus G47Δ Shows Efficacy and Safety in Glioblastoma. Cancer discovery (2022)
    7. [7]
      EGFR Mutations in GBM Alter Ligand Binding and Subsequent Dimerization. Cancer discovery (2022)
    8. [8]
      Neuronal Mechanisms Drive Whole Brain Invasion in Glioblastoma. Cancer discovery (2022)
    9. [9]
      The efficacy of hypofractionated radiotherapy (HFRT) with concurrent and adjuvant temozolomide in newly diagnosed glioblastoma: A meta-analysis. — Guo L, Li X, Chen Y, Liu R, Ren C, Du S Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique (2021)
    10. [10]
      Does local drug delivery still hold therapeutic promise for brain cancer? A systematic review. — Bastiancich C, Bozzato E, Henley I, Newland B Journal of controlled release : official journal of the Controlled Release Society (2021)
    11. [11]
      News on the horizon in glioblastoma therapy. — Herrlinger U ESMO open (2020)
    12. [12]
      Modified Poliovirus Tested in Glioblastoma. Cancer discovery (2018)
    13. [13]
      The Oncolytic Adenovirus DNX-2401 Has Antitumor Activity in Glioblastoma. Cancer discovery (2018)
    14. [14]
      With GBM, T Cells May Be Stuck in Bone Marrow. Cancer discovery (2018)
    15. [15]
      Intraoperative Subcortical Electrical Mapping of the Optic Tract in Awake Surgery Using a Virtual Reality Headset. — Mazerand E, Le Renard M, Hue S, Lemée JM, Klinger E, Menei P World neurosurgery (2017)
    16. [16]
      Patterns of failure for patients with glioblastoma following O-(2-[ — Lundemann M, Costa JC, Law I, Engelholm SA, Muhic A, Poulsen HS et al. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (2017)
    17. [17]
      End of life care for glioblastoma patients at a large academic cancer center. — Kuchinad KE, Strowd R, Evans A, Riley WA, Smith TJ Journal of neuro-oncology (2017)
    18. [18]
      Iron(III)-Based Magnetic Resonance-Imageable Liposomal T1 Contrast Agent for Monitoring Temperature-Induced Image-Guided Drug Delivery. — Kneepkens E, Fernandes A, Nicolay K, Grüll H Investigative radiology (2016)
    19. [19]
      Disseminated Intravascular Coagulation in Secondary Glioblastoma due to Excessive Intraoperative Bleeding: Case Report and Review of the Literature. — Pinggera D, Kerschbaumer J, Innerhofer N, Woehrer A, Freyschlag CF, Thomé C World neurosurgery (2016)
    20. [20]
      Stereotactic mesencephalotomy for palliative care pain control: A case report, literature review and plea to rediscover this operation. — Ivanishvili Z, Pujara S, Honey CM, Chang S, Honey CR British journal of neurosurgery (2016)
    21. [21]
      The Risk of Glioblastoma with TNF Inhibitors. — Guo M, Luo H, Samii A, Etminan M Pharmacotherapy (2016)
    22. [22]
      Novel strategies in glioblastoma surgery aim at safe, supra-maximum resection in conjunction with local therapies. — Wolbers JG Chinese journal of cancer (2014)
    23. [23]
      Super-resolution track density imaging of glioblastoma: histopathologic correlation. — Barajas RF, Hess CP, Phillips JJ, Von Morze CJ, Yu JP, Chang SM et al. AJNR. American journal of neuroradiology (2013)
    24. [24]
      Comparative tumor imaging and PDT Efficacy of HPPH conjugated in the mono- and di-forms to various polymethine cyanine dyes: part - 2. — James NS, Ohulchanskyy TY, Chen Y, Joshi P, Zheng X, Goswami LN et al. Theranostics (2013)
    25. [25]
      Botulinum toxin injection and phenol nerve block for reduction of end-of-life pain. — Fu J, Ngo A, Shin K, Bruera E Journal of palliative medicine (2013)
    26. [26]
      Quality of life and outcomes in glioblastoma management. — Colen CB, Allcut E Neurosurgery clinics of North America (2012)
    27. [27]
      Concordance between local, institutional, and central pathology review in glioblastoma: implications for research and practice: a pilot study. — Gupta T, Nair V, Epari S, Pietsch T, Jalali R Neurology India (2012)
    28. [28]
      Radiotherapy and concomitant temozolomide may improve survival of elderly patients with glioblastoma. — Barker CA, Chang M, Chou JF, Zhang Z, Beal K, Gutin PH et al. Journal of neuro-oncology (2012)
    29. [29]
      Assessment of physiological parameters within glioblastomas in awake patients: a prospective clinical study. — Whittle IR, Stavrinos N, Akil H, Yau Y, Lewis SC British journal of neurosurgery (2010)
    30. [30]
      Up-front temozolomide in elderly patients with glioblastoma. — Laigle-Donadey F, Figarella-Branger D, Chinot O, Taillandier L, Cartalat-Carel S, Honnorat J et al. Journal of neuro-oncology (2010)
    31. [31]
      Hypofractionated radiotherapy followed by adjuvant chemotherapy with temozolomide in elderly patients with glioblastoma. — Minniti G, De Sanctis V, Muni R, Rasio D, Lanzetta G, Bozzao A et al. Journal of neuro-oncology (2009)
    32. [32]
      Hydrogen peroxide upregulates TNF-related apoptosis-inducing ligand (TRAIL) expression in human astroglial cells, and augments apoptosis of T cells. — Kwon D, Choi IH Yonsei medical journal (2006)
    33. [33]
      Awake craniotomy for glioblastoma in a 9-year-old child. — Klimek M, Verbrugge SJ, Roubos S, van der Most E, Vincent AJ, Klein J Anaesthesia (2004)
    34. [34]
      Neurofibromatosis and glioblastoma in a case of multiple sclerosis. — Pál E, Gömöri E E, Gáti I European journal of neurology (2001)
    35. [35]
      Pleuropulmonary metastasis from an intracranial glioblastoma. — Greif J, Horovitz M, Marmor S Lung cancer (Amsterdam, Netherlands) (1998)
    36. [36]
      Correlation of expression of NCAM and GD3 ganglioside to motile behaviour in neoplastic glia. — Gratsa A, Rooprai HK, Rogers JP, Martin KK, Pilkington GJ Anticancer research (1997)
    37. [37]
      A novel 200 kDa plasma membrane glycoprotein with high basal tyrosine kinase activity in tumour cells. — Bishayee S Indian journal of biochemistry & biophysics (1997)
    38. [38]
      Glutamine synthetase gene expression in a glioblastoma cell-line of clonal origin: regulation by dexamethasone and dibutyryl cyclic AMP. — Arcuri C, Tardy M, Rolland B, Armellini R, Menghini AR, Bocchini V Neurochemical research (1995)
    39. [39]
      A glycoprotein expressed by human fibrous astrocytes is a hyaluronate-binding protein and a member of the CD44 family. — da Cruz LA, Cruz TF, Moscarello MA Cell adhesion and communication (1993)
    40. [40]
      Long-time survival of a patient with glioblastoma and Turcot's syndrome. Case report. — Rutz HP, de Tribolet N, Calmes JM, Chapuis G Journal of neurosurgery (1991)
    41. [41]
      Glioblastoma with sarcomatous component associated with myxoid change. A histochemical, immunohistochemical and electron microscopic study. — Kishikawa M, Tsuda N, Fujii H, Nishimori I, Yokoyama H, Kihara M Acta neuropathologica (1986)
    42. [42]
      An interim assessment of the experience of fast neutron boost in glioblastomas, rectal and bronchus carcinomas in Orleans. — Breteau N, Destembert B, Sabattier R, Schlienger M Strahlentherapie (1985)
    43. [43]
      Abetalipoproteinemia and metastatic spinal cord glioblastoma. — Newman RP, Schaefer EJ, Thomas CB, Oldfield EH Archives of neurology (1984)
    44. [44]
      Glioblastoma of the brainstem associated with Hodgkin lymphoma. — Ederli A, Lo Russo F, Vesentini G Italian journal of neurological sciences (1983)
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