A 62-year-old man with a WHO grade IV glioblastoma (GBM) undergoes maximal safe resection followed by standard Stupp protocol. What does the Stupp protocol consist of?

• A Radiotherapy 60 Gy alone without chemotherapy
• B Bevacizumab + irinotecan as first-line adjuvant regimen
• C PCV (procarbazine, CCNU, vincristine) for 12 months after radiotherapy
• D Concurrent temozolomide + radiotherapy followed by 6 cycles of adjuvant temozolomide ✓

Explanation

The Stupp protocol (NEJM 2005) for newly diagnosed GBM: radiotherapy 60 Gy in 30 fractions over 6 weeks with concurrent temozolomide (75 mg/m²/day), followed by 6 cycles of adjuvant temozolomide (150–200 mg/m²/day for 5 days every 28-day cycle). This improved median OS from 12 to 14.6 months vs RT alone, with 2-year survival of 26%. MGMT promoter methylation predicts benefit from temozolomide. Bevacizumab is used at recurrence, not first-line.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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