Glioblastoma and Other IDH-wildtype Diffuse Glioma
Recommendation 2.1
➤ People with astrocytomas, IDH-wildtype, CNS WHO grade 2 or 3 may be
treated according to recommendations for glioblastoma, IDH-wildtype,
CNS WHO grade 4 found in this guideline. (Weak recommendation; IC-VL)
Recommendation 2.2
➤ Concurrent temozolomide and radiation therapy should be offered to
people with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO
grade 4. (Strong recommendation; EB-B-M)
Qualifying Statement: With the exception of studies addressing glioblastoma diagnosis in
people of older age or poor performance status, no prospective, randomized evidence provides a
sufficient basis to guide decision-making based on MGMT promotor methylation status.
Recommendation 2.3
➤ Six months of adjuvant temozolomide should be offered to people with
newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 who
have received concurrent radiation therapy plus temozolomide. (Strong
recommendation; EB-B-M)
Recommendation 2.4
➤ Alternating electric field therapy may be added to adjuvant
temozolomide in people with newly diagnosed supratentorial
glioblastoma, IDH-wildtype, CNS WHO grade 4 who have completed
chemoradiation therapy. (Weak recommendation; EB-B-M)
Recommendation 2.5
➤ Bevacizumab is NOT recommended for people with newly diagnosed
glioblastoma, IDH-wildtype, CNS WHO grade 4. (Weak recommendation;
EB-U-M)
Recommendation 2.6
➤ In people with glioblastoma, IDH-wildtype, CNS WHO grade 4 where the
expected survival benefits of a six-week radiation course combined with
temozolomide may not outweigh the harms, hypofractionated radiation
therapy combined with temozolomide is a reasonable alternative. See
guideline for further explanation. (Weak recommendation; EB-B-M)
