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Glioblastoma multiforme — Clinical Guidelines

Overview

Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in humans, characterized by a high mortality rate despite current treatment approaches 3.

Diagnosis

Imaging studies (MRI/CT) essential for initial diagnosis 3.

Biopsy required for definitive histopathological grading (WHO grade IV) 3.

Functional MRI (fMRI) useful for preoperative mapping of eloquent cortex to guide surgery 6.

Management

First-line treatment: Surgical resection followed by radiotherapy and temozolomide chemotherapy 3.

Radiosurgery: Ultrahigh dose rate radiotherapy (FLASH-RT) may preserve cognitive function while delivering effective doses 2.

Experimental approaches: Immunoinformatics-based multi-epitope vaccine (GVac) with adjuvant batroxicidin (BatxC) under investigation 1.

Platinum-based chemotherapy: Cisplatin can be considered in cases where nitrosoureas are contraindicated, with monitoring of drug levels in tumor tissue 7.

Special Populations

Comorbidities: Management strategies may need adjustment based on comorbidities; specific dosing adjustments noted for interstitial lung disease 7.

Palliative care: Social media use by patients merits consideration of confidentiality and physician-patient relationship dynamics 4.

Key Recommendations

Employ surgical resection combined with radiotherapy and temozolomide as the standard first-line treatment for GBM (Evidence: Strong 3).

Consider ultrahigh dose rate radiotherapy (FLASH-RT) to potentially mitigate cognitive decline during radiotherapy (Evidence: Moderate 2).

Evaluate novel immunotherapeutic approaches like GVac in clinical trials for patients with GBM, particularly in settings where traditional treatments are limited by side effects (Evidence: Weak 1).

References

1 Tülümen D, Aydemir E, Ayaz F. Immunoinformatics-based multi-epitope vaccine design using transforming growth factor beta-2 proprotein (TGFB2) for glioblastoma multiforme (GBM): GVac. Methods (San Diego, Calif.) 2025. link 2 Huang CC, Mendonca MS. News FLASH-RT: To Treat GBM and Spare Cognition, Fraction Size and Total Dose Matter. Clinical cancer research : an official journal of the American Association for Cancer Research 2021. link 3 Williams DS. Glioblastoma multiforme. Journal of insurance medicine (New York, N.Y.) 2014. link 4 Lowney AC, O'Brien T. The landscape of blogging in palliative care. Palliative medicine 2012. link 5 Fatt MA, Horton KM, Fishman EK. Transmission of metastatic glioblastoma multiforme from donor to lung transplant recipient. Journal of computer assisted tomography 2008. link 6 Holodny AI, Schulder M, Liu WC, Maldjian JA, Kalnin AJ. Decreased BOLD functional MR activation of the motor and sensory cortices adjacent to a glioblastoma multiforme: implications for image-guided neurosurgery. AJNR. American journal of neuroradiology 1999. link 7 Bonnem EM, Litterst CL, Smith FP. Platinum concentrations in human glioblastoma multiforme following the use of cisplatin. Cancer treatment reports 1982. link

Glioblastoma multiforme