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Glioblastoma — SCE Medical Oncology MCQ

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ModerateCNS TumoursGlioblastomaSCE Medical Oncology

A 75‑year‑old man with newly diagnosed glioblastoma has an ECOG performance status of 2 and multiple comorbidities. The MGMT promoter is methylated, and only a biopsy (no resection) has been performed. What is the most appropriate treatment approach?

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Correct answer: E — Hypofractionated radiotherapy (40 Gy in 15 fractions) with concurrent and adjuvant temozolomide

Option E is correct. NICE NG99 (UK) recommends for patients aged around 70 or over with newly diagnosed grade 4 glioma (glioblastoma), MGMT methylation, and reasonable performance status (KPS ≥70 or equivalent), hypofractionated radiotherapy (40 Gy in 15 fractions) with concurrent and up to 12 cycles of adjuvant temozolomide. This balances efficacy with tolerability in elderly, comorbid patients after biopsy only. Option A (standard 60 Gy) is too intensive for this population. Option B (TMZ alone) lacks radiotherapy benefit. Option C (bevacizumab monotherapy) is not recommended in first‑line per NICE. Option D (supportive care) would be considered only if performance status were worse (e.g. ECOG ≥3).

Reference: NICE NG99: Brain tumours (primary) and brain metastases in over 16s, Recommendation 1.2.20 and Rationale and impact section, 2018 (updated 2021), https://www.nice.org.uk/guidance/ng99/chapter/recommendations