Glioblastoma treatment follows a well-established sequence: surgery first, then six weeks of combined radiation and chemotherapy, followed by months of additional chemotherapy. Even with aggressive treatment, the five-year survival rate is roughly 5% to 7%, but each step in the process is designed to extend life and preserve quality of life for as long as possible.
Surgery Is the First Step
The primary goal of glioblastoma surgery is to remove as much visible tumor as possible, ideally achieving what’s called a gross total resection, meaning no remaining tumor is visible on a post-operative MRI. When surgeons achieve this, survival can extend to 20 to 25 months. That’s a meaningful improvement over partial removal or biopsy alone.
Complete removal isn’t always possible. Glioblastoma often grows into areas of the brain that control speech, movement, or other critical functions. In those cases, surgeons remove what they safely can while preserving neurological function. Even a partial resection reduces the tumor’s bulk, relieves pressure inside the skull, and makes the remaining cells more vulnerable to radiation and chemotherapy. The tissue removed during surgery also provides the molecular information needed to guide the rest of treatment.
Radiation and Chemotherapy Together
About four to five weeks after surgery, most patients begin a six-week course of daily radiation paired with a daily oral chemotherapy pill. The radiation delivers a total of 60 Gray across 30 sessions, one session per weekday. The chemotherapy runs alongside radiation every single day during this period, including weekends, at a relatively low dose designed to make the tumor cells more sensitive to the radiation.
For older patients or those in poorer health, a shorter radiation course (three weeks instead of six, at a lower total dose) works just as well. There’s no evidence that the longer schedule is more effective in this group, and the shorter version is easier to tolerate.
This combined phase is physically demanding. Fatigue tends to build over the six weeks, and many patients experience nausea, loss of appetite, or headaches. Blood counts need to be monitored regularly because the chemotherapy suppresses immune cell production.
Maintenance Chemotherapy
After the combined phase, patients take a four-week break, then begin up to six additional monthly cycles of the same chemotherapy drug at a higher dose. Each cycle involves taking the pill daily for five days, then going 23 days without it. The dose typically starts lower in the first cycle and increases in the second cycle if blood counts remain stable and side effects are manageable.
This maintenance phase stretches roughly six months. Fatigue, nausea, and lowered blood counts remain the primary concerns. Regular blood work determines whether the next cycle can proceed on schedule or needs to be delayed.
How MGMT Status Shapes Your Outlook
One of the most important pieces of information from your tumor biopsy is a molecular marker called MGMT promoter methylation. In simple terms, this marker tells doctors whether the tumor has a weakened ability to repair the DNA damage caused by chemotherapy. About 30% to 40% of glioblastomas have this marker.
If your tumor is MGMT-methylated, the standard chemotherapy is significantly more effective. These patients tend to experience slower tumor progression and better survival outcomes with chemoradiation. Importantly, the benefit of this marker only shows up when patients actually receive chemoradiation. The methylation status on its own, without treatment, doesn’t change the trajectory. This is why testing for it matters: it helps predict how well the standard regimen will work for you specifically.
Tumor Treating Fields
A wearable device that delivers low-intensity electric fields to the scalp is now part of the treatment toolkit. The device uses adhesive arrays placed on the shaved head, connected to a portable battery pack. These electric fields disrupt the process of cell division, slowing tumor growth.
The catch is commitment. The device needs to be worn at least 18 hours per day on average to be effective. Patients who use it fewer than 13 hours daily may not benefit enough to justify continuing. That means wearing it during sleep, work, and most daily activities, with breaks only for showering and changing the electrode arrays. Some patients find this manageable; others find it burdensome. The arrays can cause skin irritation on the scalp, which is the most common side effect.
Managing Swelling and Symptoms
Glioblastoma causes significant swelling in the surrounding brain tissue, which often produces headaches, weakness, difficulty thinking, or seizures. Steroids are the primary tool for controlling this swelling. Patients with mild symptoms typically start at a lower dose, while those with severe symptoms or signs of dangerous pressure buildup may need much higher doses.
Steroids work quickly and can dramatically improve symptoms within days, but long-term use comes with real trade-offs. In studies of brain tumor patients on steroids, 46% experienced increased appetite or weight gain, 28% developed muscle weakness (particularly in the thighs and upper arms), 24% had insomnia, and 20% reported gastrointestinal problems. Doctors try to taper the dose to the lowest effective level as soon as possible, but some patients need steroids throughout their treatment course.
Seizures affect a substantial portion of glioblastoma patients and are managed with anti-seizure medications. Fatigue, cognitive changes, and mood shifts are also common, whether from the tumor itself, the swelling, or the treatments. Palliative care teams can help manage these overlapping symptoms from early in the diagnosis, not just at the end of life.
When the Tumor Comes Back
Glioblastoma recurrence is expected rather than exceptional. When it happens, options become more limited. A second surgery may be considered if the new growth is accessible and the patient is healthy enough. Repeat radiation is sometimes possible depending on the location and how much was delivered previously.
A drug that blocks blood vessel growth in tumors is FDA-approved for recurrent glioblastoma. It works by starving the tumor of its blood supply, which can reduce swelling and shrink the visible tumor on scans. About 26% of patients in clinical studies showed a measurable response along with stable or reduced need for steroids. However, an important caveat: this drug has not been shown to extend overall survival. It can improve symptoms and quality of life, which is why it remains in use, but expectations should be calibrated accordingly.
Immunotherapy in Early Testing
Engineered immune cells designed to recognize and attack tumor proteins are being tested in early-stage clinical trials for glioblastoma. One trial targeting a specific protein found on glioblastoma cells treated 65 patients and achieved disease control in 50% of them, with 23% surviving at least one year. Those numbers are modest but notable for a population with very few options.
The major challenge is that glioblastoma adapts. Tumors have been documented to stop producing the very proteins these immune cells are designed to target, rendering the treatment less effective over time. Newer trials are testing immune cells engineered to recognize multiple tumor proteins simultaneously, hoping to cut off this escape route. These approaches have shown early biological activity and brief tumor responses on imaging, but remain experimental. No immunotherapy is currently approved as a standard treatment for glioblastoma.