What are the NCCN guidelines on diagnosis and treatment of glioblastoma multiforme (GBM)?

Updated: Jul 28, 2021
  • Author: Jeffrey N Bruce, MD; Chief Editor: Herbert H Engelhard, III, MD, PhD, FACS, FAANS  more...
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Answer

The National Comprehensive Cancer Network (NCCN) has released guidelines on central nervous system (CNS) cancers which includes recommendations for the diagnosis and treatment of glioblastomas (grade IV gliomas). The goals of surgery are to obtain a diagnosis, alleviate symptoms of increased intracranial pressure or compression, increase survival, and decrease the need for corticosteroids. Adjuvant treatment options depend on the patient performance status (PS), age, and MGMT promoter methylation status. [58]  

Category 1 recommendations for first-line treatment [58] :

  • Patients 70 years or younger with good PS, regardless of the tumor's MGMT methylation status, should receive fractionated standard brain radiation therapy (RT) plus concurrent and adjuvant temozolomide (TMZ) with or without alternating electric field therapy.
  • Patients older than 70 years with good PS and MGMT promoter–methylated tumors should receive hypofractionated brain RT plus concurrent and adjuvant TMZ or standard brain RT plus concurrent and adjuvant TMZ and alternating electric field therapy.
  • Patients older than 70 years with good PS and MGMT unmethylated or indeterminant tumors should receive standard brain RT plus concurrent and adjuvant TMZ and alternating electric field therapy.

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