A 35-year-old man presents with headache and focal seizures. MRI brain shows a 4 cm ring-enhancing lesion in the right temporal lobe with mass effect and midline shift. He is immunocompetent with no systemic cancer history. Stereotactic biopsy shows IDH-mutant, MGMT promoter-methylated glioblastoma. According to the EORTC 26981/NCIC CE3 trial (Stupp protocol), what is the standard of care?
- A Temozolomide chemotherapy alone for 6 cycles
- B Maximal safe surgical resection followed by radiotherapy alone
- C Maximal safe surgical resection followed by concurrent temozolomide and radiotherapy, then adjuvant temozolomide ✓
- D Bevacizumab (anti-VEGF) plus temozolomide as primary treatment
Correct answer: C. Maximal safe surgical resection followed by concurrent temozolomide and radiotherapy, then adjuvant temozolomide
Explanation
The Stupp protocol (EORTC 26981 trial, Stupp et al. 2005) established maximal safe surgical resection followed by 60 Gy radiotherapy concurrent with temozolomide (75 mg/m2/day), then 6 cycles of adjuvant temozolomide (150-200 mg/m2 days 1-5 of each 28-day cycle) as standard of care for newly diagnosed glioblastoma. MGMT promoter methylation predicts benefit from temozolomide. IDH mutation confers better prognosis but does not change the treatment protocol for glioblastoma grade IV.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.