Update on the current management of glioblastoma

Glioblastoma is the most common primary brain tumor in adults, with a rising incidence, predominantly in the older population. Aggressive treatment involves maximal safe resection followed by radiation with concurrent and adjuvant temozolomide. The added benefit of temozolomide in subsets of patients who were not included in the landmark, randomized study is under investigation. Despite multimodal treatment, median survival ranges between 12 and 18 months. The majority of patients suffer local tumor progression or recurrence, for which management is highly personalized, considering the patient's clinical presentation, performance status and the extent of tumor recurrence in order to optimize each patient's outcome. Advances in surgical techniques and radiotherapy have decreased treatment-related morbidity at initial treatment and enabled consideration of repeated local therapies in selected situations. Ongoing research into the underlying molecular and cytogenetic pathways responsible for tumor growth and progression are facilitating the development and investigation of targeted therapies.