Glioblastoma, newly diagnosed

Typical sequence for Newly diagnosed disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

1. 1. MRI and surgery

   weeks 0-2

   Contrast MRI then maximal safe resection (or biopsy) usually within 1-2 weeks; molecular testing for IDH, MGMT methylation and 1p/19q.

   MRIFluorescence-guided surgeryComprehensive genomic profiling
   Source
   Decision: Is MGMT methylated, and is the patient fit for the full course?

   • Fit: 6-week chemoradiotherapy then temozolomide
   • Older or frail: short-course radiotherapy, with temozolomide if MGMT is methylated
   • IDH-mutant (grade 2-3 glioma, not glioblastoma): a different, slower pathway including vorasidenib
2. 2. Recovery

   weeks 1-6

   Wound healing and steroids tapering before radiotherapy starts, typically 3-5 weeks after surgery.

   Source
3. 3. Chemoradiotherapy

   weeks 4-10

   60 Gy in 30 fractions over 6 weeks with daily temozolomide (Stupp protocol); a shorter 3-week course is used in older or frailer patients.

   ⟳TemozolomideIMRT / IGRT (modern external beam)
   Source
4. 4. Break

   weeks 10-14

   Four weeks off treatment, then a baseline MRI.

   MRI
   Source
5. 5. Adjuvant temozolomide

   weeks 14-38

   Six 28-day cycles, tablets on days 1-5; tumour treating fields (EF-14) can be worn alongside.

   ⟳TemozolomideTumour treating fields (TTFields)
   Source
6. 6. MRI surveillance

   from week 38, continues for years

   MRI every 2-3 months; pseudoprogression in the first months can mimic recurrence.

   MRI
   Source

Sources

• https://www.nejm.org/doi/full/10.1056/NEJMoa043330
• https://doi.org/10.1001/jama.2017.18718
• https://www.nccn.org/guidelines/category_1