Glioblastoma (GBM) is the most aggressive form of primary brain cancer, classified by the World Health Organization (WHO) as a Grade IV tumor due to its rapid growth and highly infiltrative nature. Surgery is the foundational first step in treatment, serving to acquire tissue for a definitive diagnosis and to remove the maximum amount of tumor possible (maximal safe resection). While surgery reduces the tumor burden and alleviates immediate pressure symptoms, GBM cells extend microscopic projections into surrounding brain tissue, making complete removal extremely difficult. The period immediately following the operation transitions the patient from initial intervention to the long-term, multidisciplinary therapy required to address remaining cancer cells.
Immediate Post-Operative Recovery and Discharge
The initial recovery phase focuses on physical stabilization, beginning immediately after the procedure. Patients are closely monitored in a specialized unit for the first 24 to 48 hours before moving to a standard hospital room. The typical hospital stay for brain tumor resection is between three to seven days, varying based on tumor location and the patient’s overall health.
Immediate expectations include managing pain and swelling, often manifesting as a significant headache. Medications control this pain, and corticosteroids, such as Dexamethasone, are frequently administered to reduce brain swelling around the surgical site. Wound care involves monitoring the incision, which may be closed with staples or dissolvable sutures. Patients are instructed to keep the area clean and dry. Before discharge, a post-operative magnetic resonance imaging (MRI) or computed tomography (CT) scan is performed to assess the extent of the resection and check for complications.
Transitioning home or to a rehabilitation facility depends on a functional assessment conducted by physical and occupational therapists. These evaluations ensure the patient can perform basic tasks, such as walking, self-care, and safely navigating stairs, potentially with new deficits. Patients must avoid strenuous activity, heavy lifting, and vigorous exercise for several weeks to allow the craniotomy site to heal fully. Physical healing during this period prepares the body for the rigorous treatment schedule that follows.
Standard Adjuvant Treatment Protocol
Once the surgical wound has healed, typically within four to six weeks, the patient begins the standard adjuvant treatment, a structured regimen designed to target residual, microscopic tumor cells. This protocol, often called the Stupp Regimen, combines radiation therapy with concurrent chemotherapy.
The concurrent phase involves daily, focused radiation doses delivered over approximately six weeks, totaling 60 Gray (Gy). Simultaneously, patients take a daily, low-dose oral chemotherapy drug called Temozolomide (TMZ). TMZ is an alkylating agent that enhances the effectiveness of the radiation therapy. This concurrent phase lasts about six weeks, followed by a break of several weeks to allow the body to recover.
The next component is the maintenance phase, consisting of cycles of higher-dose Temozolomide taken alone. A cycle spans 28 days: medication is taken for five consecutive days, followed by a 23-day break. Patients generally undergo six to twelve cycles of maintenance chemotherapy, depending on tolerance and disease stability. Throughout both phases, progress is monitored with regular brain MRI scans to check for treatment response and signs of tumor regrowth.
Managing Symptoms and Functional Changes
The tumor, surgery, and aggressive treatment protocol create a unique set of symptoms and functional changes that require management. Neurological deficits are common and depend on the tumor’s location. These may include:
- Difficulties with speech
- Alterations in personality or mood
- Motor weakness on one side of the body
- Cognitive impairment (often described as “brain fog”)
These changes can be immediate consequences of surgery or develop gradually as treatment affects specific brain regions. Profound fatigue, often disproportionate to activity levels, is a frequently reported side effect of the disease and chemoradiation. Managing fatigue involves balancing rest with light activity, often prescribed by a physical therapist.
Chemotherapy requires frequent blood count monitoring. Temozolomide can suppress bone marrow function, leading to reduced white blood cell counts (lymphocytopenia) and increasing the risk of infection.
Many patients remain on corticosteroids like Dexamethasone after surgery to minimize swelling and reduce seizure risk. Long-term use of these medications introduces side effects, including weight gain, mood changes, difficulty sleeping, and muscle weakness, all requiring careful management. To address functional deficits, support services are indispensable: physical therapy regains mobility, occupational therapy adapts daily activities for independence, and speech therapy addresses language or swallowing difficulties. These interventions maintain the highest possible quality of life.
Prognosis and Advanced Care Planning
Glioblastoma Grade IV carries a serious prognosis, even after maximal surgical resection and the full Stupp Regimen. The median overall survival for patients receiving standard treatment typically falls within the range of 15 to 21 months. This number is a statistical median, meaning individual outcomes are highly variable. Outcomes are influenced by factors such as molecular markers (like MGMT promoter methylation status) and the extent of surgical resection.
A major consideration is the high probability of tumor recurrence, as GBM is known for its ability to regrow despite aggressive therapy. Post-treatment surveillance with regular MRI scans is therefore a continuous process.
Given that the disease can progressively impair cognitive function and decision-making capacity, advanced care planning (ACP) is strongly recommended early in the disease course. Advanced directives allow a patient to articulate their wishes for future medical care while they are still able to make sound decisions. Palliative care should be introduced early, not as an alternative to active treatment, but as a specialized medical service focused on managing symptoms and improving the quality of life for the patient and their family. Early engagement helps ensure treatment goals remain aligned with the patient’s values.