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Glioblastoma — SCE Medical Oncology MCQ

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HardCNS TumoursGlioblastomaSCE Medical Oncology

A 74-year-old with newly diagnosed glioblastoma has Karnofsky performance status 80 and a methylated MGMT promoter after maximal safe resection. Which postoperative regimen is specifically offered by NICE for this age and biomarker group?

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Correct answer: B — Radiotherapy 40 Gy in 15 fractions with concomitant and adjuvant temozolomide

For an older fit patient with MGMT-methylated glioblastoma, NICE specifically offers 40 Gy in 15 fractions with concomitant and adjuvant temozolomide. Radiotherapy 40 Gy in 15 fractions followed by adjuvant temozolomide: the biomarker-selected NICE regimen includes concomitant as well as adjuvant temozolomide. Radiotherapy 60 Gy in 30 fractions with concomitant and adjuvant temozolomide: this conventional six-week schedule is less well matched to the stated older-patient recommendation. Temozolomide monotherapy for six cycles with MRI response assessment: a fit 74-year-old with KPS 80 can receive hypofractionated radiotherapy combined with temozolomide. Radiotherapy 34 Gy in 10 fractions with concomitant temozolomide: this is not the specific dose-fractionation and combined schedule recommended in the scenario.

Reference: NICE NG99 brain tumours and metastases: recommendations (Updated January 2021; current surveillance): https://www.nice.org.uk/guidance/ng99/chapter/recommendations; Temodal UK summary of product characteristics (Current UK SmPC, accessed July 2026): https://www.medicines.org.uk/emc/product/1463/smpc