What causes Glioblastoma? Read More
How is glioblastoma diagnosed and detected? Read More
A rare tumour with less than 10 per 100,000 people affected globally Read More

Recurrent Glioblastoma

What are the available treatment options for glioblastoma?

Treatment plan for glioblastoma involves a multimodal approach.

Treatment plan for glioblastoma involves a multimodal approach – in other words, a combination of approaches.

I. Surgery

Surgery is invariably the first step of treatment of glioblastoma. Surgical procedure helps in diagnosis, in relieving pressure on the brain and to safely remove as much tumour as possible. Surgery is performed very carefully so as to not disrupt important regions of the brain that control many motor activities.

II. Chemotherapy & Radiation

Since the publication of a landmark clinical trial in 2005, the standard-of-care for GBM has been maximal safe surgical removal of cancer, followed by radiotherapy and chemotherapy with temozolomide (TMZ), an oral alkylating chemotherapy agent.

III. Targeted therapy

Bevacizumab, a monoclonal antibody, is the only targeted therapy approved for the treatment of recurrent glioblastoma so far. Bevacizumab works by binding to a protein called vascular endothelial growth factor (VEGF), thereby blocking cell proliferation and new blood vessel formation and the site of tumour. Specifically in case of GBM, progression free survival due to bevacizumab could be more due to the drug’s ability to decrease blood-brain barrier permeability when compared to an anti-tumour effect.


CT/CAT scan: Computed Tomography scan GBM: Glioblastoma multiforme MRI scan: Magnetic resonance imaging scan MRS: Magnetic resonance spectroscopy PET scan: Positron emission tomography scan rGBM: Recurrent glioblastoma multiforme TMZ: temozolomide VEGF: Vascular Endothelial Growth Factor


  1. Hanif, F., Muzaffar, K., Perveen, K., Malhi, S. M., & Simjee, S. (2017). Glioblastoma Multiforme: A Review of its Epidemiology and Pathogenesis through Clinical Presentation and Treatment. Asian Pacific journal of cancer prevention : APJCP, 18(1), 3–9. doi:10.22034/APJCP.2017.18.1.3
  2. Rock, K., Mcardle, O., Forde, P., Dunne, M., Fitzpatrick, D., O’Neill, B., & Faul, C. (2012). A clinical review of treatment outcomes in glioblastoma multiforme—the validation in a non-trial population of the results of a randomised Phase III clinical trial: has a more radical approach improved survival? The British Journal of Radiology, 85(1017), e729-e733. doi:10.1259/bjr/83796755
  3. Loeffler, J., Alexander, E., Hochberg, F. H., Wen, P. Y., Morris, J. H., Schoene, W. C., … Black, P. M. (1990). Clinical patterns of failure following stereotactic interstitial irradiation for malignant gliomas. International Journal of Radiation Oncology Biology Physics, 19(6), 1455-1462. doi:10.1016/0360-3016(90)90358-q
  4. Gaspar, L. E., Fisher, B. J., Macdonald, D. R., Leber, D. V., Halperin, E. C., Schold, S., & Cairncross, J. (1992). Supratentorial malignant glioma: Patterns of recurrence and implications for external beam local treatment. International Journal of Radiation Oncology Biology Physics, 24(1), 55-57. doi:10.1016/0360-3016(92)91021-e
  5. Ansari, M., Nasrolahi, H., Kani, A. A., Mohammadianpanah, M., Ahmadloo, N., Omidvari, S., & Mosalaei, A. (2012). Pediatric glioblastoma multiforme: A single-institution experience. Indian journal of medical and paediatric oncology : official journal of Indian Society of Medical & Paediatric Oncology, 33(3), 155-60.
  6. Prasad, G., & Haas-Kogan, D. A.(2009).Radiation-induced gliomas.Expert review of neurotherapeutics,9(10),1511-7
  7. McKinley, B. P., Michalek, A. M., Fenstermaker, R. A., & Plunkett, R. J. (2000). The impact of age and gender on the incidence of glial tumors in New York state from 1976–1995. Journal of Neurosurgery, 93(6), 932-939. doi:10.3171/jns.2000.93.6.0932
  8. Eefje M. Sizoo, Lies Braam, Tjeerd J. Postma, H. Roeline W. Pasman, Jan J. Heimans, Martin Klein, Jaap C. Reijneveld, Martin J. B. Taphoorn, Symptoms and problems in the end-of-life phase of high-grade glioma patients, Neuro-Oncology, Volume 12, Issue 11, November 2010, Pages 1162–1166, https://doi.org/10.1093/neuonc/nop045
  9. Carlsson, S. K., Brothers, S. P., & Wahlestedt, C. (2014). Emerging treatment strategies for glioblastoma multiforme. EMBO molecular medicine, 6(11), 1359-70.
  10. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, et al. (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352: 987–996.
  11. Friedman, H. S., Prados, M. D., Wen, P. Y., Mikkelsen, T., Schiff, D., Abrey, L. E., … Cloughesy, T. (2009). Bevacizumab Alone and in Combination With Irinotecan in Recurrent Glioblastoma. Journal of Clinical Oncology, 27(28), 4733-4740. doi:10.1200/jco.2008.19.8721
  12. Wick, W., Weller, M., Van den Bent, M., & Stupp, R. (2010). Bevacizumab and Recurrent Malignant Gliomas: A European Perspective. Journal of Clinical Oncology, 28(12), e188-e189. doi:10.1200/jco.2009.26.9027
  13. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®: Central Nervous System Cancers, Version 2.2018, Nov 26, 2018