A 45-year-old man presents with new-onset seizures. MRI shows a ring-enhancing lesion with central necrosis and surrounding oedema in the right temporal lobe. Stereotactic biopsy confirms IDH-wild-type glioblastoma multiforme (GBM), MGMT promoter methylated. According to EORTC 26981/22981 (Stupp protocol) and current ESMO guidelines, the standard treatment is:
- A Maximal safe surgical resection followed by radiotherapy (60 Gy in 30 fractions) alone
- B Maximal safe surgical resection, followed by concurrent radiotherapy (60 Gy) with temozolomide, then 6 cycles adjuvant temozolomide — with particular benefit in MGMT-methylated tumours ✓
- C Stereotactic radiosurgery (SRS) alone for resectable GBM in eloquent cortex
- D Bevacizumab plus temozolomide upfront without radiotherapy
Explanation
The Stupp protocol (EORTC 26981/22981, NEJM 2005) established concurrent temozolomide with radiotherapy (60 Gy in 30 fractions) followed by 6 cycles of adjuvant temozolomide as the standard of care for newly diagnosed GBM, improving median OS from 12.1 to 14.6 months. MGMT promoter methylation predicts significantly greater benefit from temozolomide (OS 21.7 vs 12.7 months in methylated vs unmethylated tumours). Maximal safe resection remains the initial step. Bevacizumab does not improve OS in newly diagnosed GBM (RTOG 0825, AVAglio trials). MGMT methylation status should guide intensity of discussion about temozolomide benefit.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.