# Treatment methods for glioblastoma
Glioblastoma is almost always treated with a combination of treatments. The main methods are surgery, radiation therapy, and chemotherapy, often followed by long-term treatment or investigation of new therapies. The choice depends on factors such as the size and location of the tumor, your overall health, and what your own team recommends.
Surgery
The first step is usually an operation to remove as much of the tumor as possible. Surgeons try to spare as much healthy brain tissue as possible, while removing as much tumor tissue as safely can be done.
During surgery, tools can be used to better visualize the boundaries of the tumor, for example by injecting fluorescent dye or using advanced imaging in the operating room. Sometimes strict guidance of imaging and electrical nerve stimulation helps to identify and protect important nerves.
ProveniIncluded in official guidelines, or approved by EMA or FDA
How it works: Removal of tumor tissue reduces the disease burden and makes room for subsequent treatments. Studies show that more extensive removal in many cases is associated with longer survival.
Known side effects: Infection, bleeding, swelling of brain tissue, temporary or permanent loss of nerve function (speech, movement, memory), thrombosis (blood clot in a blood vessel).
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Radiation (Radiotherapy)
After surgery, patients usually receive radiation therapy directed at the tumor and nearby tissue. This usually happens daily, spread over weeks.
Recent studies examine whether less frequent radiation (so-called 'hypofractionation') works equally well with less burden. This remains under investigation.
ProveniIncluded in official guidelines, or approved by EMA or FDA
How it works: Ionizing radiation damages the DNA of tumor cells, so they can no longer multiply and die.
Known side effects: Fatigue, headache, hair loss in the radiated area, skin irritation, nausea, in the long term sometimes brain softening (necrosis of brain tissue) or secondary tumors.
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Chemotherapy
The most common chemotherapy for glioblastoma is temozolomide, a pill you take during and after radiation therapy.
ProveniIncluded in official guidelines, or approved by EMA or FDA
How it works: Temozolomide damages cell DNA and impedes their growth. It penetrates the blood-brain barrier reasonably well.
Known side effects: Blood cells may decrease (increased risk of infection or bleeding), nausea, vomiting, fatigue, sometimes more serious reactions such as pneumonia or rash.
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Treatment of recurrence
When the tumor returns or grows after initial treatment, new options are considered. This may be radiation therapy again (if sufficient time has elapsed), other chemotherapies, or participation in clinical trials with new drugs.
Bevacizumab
This is an antibody that inhibits blood vessel growth, so the tumor receives fewer nutrients.
ProveniIncluded in official guidelines, or approved by EMA or FDA
How it works: Bevacizumab blocks growth factor VEGF and limits the formation of new blood vessels around the tumor. This can slow tumor growth.
Known side effects: High blood pressure, protein in urine, risk of blood clots and impaired wound healing, fatigue, diarrhea.
Other chemotherapies at recurrence
For glioblastoma recurrence, chemotherapies are sometimes used that work differently than temozolomide, for example ifosfamide, nitrosoureas, or other drugs. The choice strongly depends on what you have had before and how your body responded to it.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Known side effects: Vary greatly depending on the drug; typically nausea, fatigue, decrease in blood cells, kidney or bladder problems.
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Experimental and investigated approaches
Immunotherapy
Studies are testing combinations where immune drugs (for example antibodies against PD-L1 or other checkpoint inhibitors) are used together with radiation or chemotherapy. The goal is to better use the immune system against tumor cells.
ResearchediPositive results in clinical studies, not yet standard treatment
How it works: These drugs help immune cells release the brakes and better recognize and attack tumor cells.
Known side effects: Immune-related reactions such as organ inflammation, pneumonitis, colitis, skin rash.
Vaccine therapy
Some studies are testing vaccines aimed at tumor antigens, with the goal of activating the body's own immune system against glioblastoma cells.
ResearchediPositive results in clinical studies, not yet standard treatment
How it works: Vaccine helps the body recognize tumor-specific characteristics and build an immune response.
Known side effects: Vaccine reactions, such as fever, fatigue, local reaction at the injection site.
Radiotherapy in other schedules
Studies are testing very short radiation schedules (ultra-hypofractionation) to make treatment shorter and more tolerable while maintaining effectiveness.
ResearchediPositive results in clinical studies, not yet standard treatment
How it works: Same principle as conventional radiation, but in fewer sessions with higher doses per session.
Known side effects: Similar to conventional radiation, but effects may be distributed differently.
Targeted therapies against genetic mutations
Because glioblastomas have different genetic mutations, research is exploring whether drugs targeting specific mutations (for example IDH mutations or EGFR alterations) are beneficial.
ExperimentaliOngoing in study setting, outcome still unknown
How it works: Inhibits certain growth pathway in tumor cells that arises from a mutation.
Known side effects: Highly dependent on the specific drug; typically skin or intestinal reactions, liver abnormalities.
Thermal or magnetic therapies
Laboratory studies are testing new approaches using heat or magnetic fields, sometimes combined with nanoparticles or gels.
ExperimentaliOngoing in study setting, outcome still unknown
These are still very new approaches in the laboratory or early clinical stage.
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Supportive care and symptom management
In addition to the treatments mentioned above, care for symptoms and consequences is important:
- **Swelling management:** Corticosteroids (especially dexamethasone) help reduce swelling of brain tissue, especially after surgery and during progression.
- **Seizure prevention:** Anticonvulsants may be needed to reduce the risk of seizures.
- **Rehabilitation:** Speech therapy, physiotherapy and occupational therapy help with speech and movement disorders.
- **Psychological support:** Guidance from psychologists or social workers helps with processing and adaptation.
- **Pain management:** Analgesics for headache and other discomfort.
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Choice of treatment
Which treatment or combination is appropriate depends on:
- The precise location, size and genetic characteristics of the tumor
- Your age and overall health
- Previously undergone treatments
- What possible options and risks have been discussed with your treatment team
- Whether you want to participate in clinical trials
No two glioblastomas are the same, and no two patients respond identically. This is why regular consultation with your team is essential.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._