Who should read this?
Patients and families facing glioblastoma that cannot be safely removed surgically (including multifocal disease), and anyone trying to understand what “standard treatment” means in this situation.
Why surgery is sometimes not possible
Glioblastoma may be multifocal (involving more than one area of the brain) or located in regions where surgery would cause significant neurological harm.
In these situations, the safest approach is often to confirm the diagnosis with a biopsy (when feasible) and move promptly to non-surgical treatment.
What “standard treatment” usually involves
Radiotherapy
Radiotherapy is the backbone of treatment when surgery cannot remove the tumour. It aims to control visible disease and slow regrowth.
Temozolomide chemotherapy (in selected patients)
Temozolomide is often given during radiotherapy and then continued afterwards. It is used in people who are likely to tolerate it and where meaningful benefit is expected.
Supportive care alongside treatment
Supportive care is an essential part of treatment and may include:
• seizure control
• steroids only when needed (with careful tapering)
• rehabilitation and allied health support
• symptom control and early supportive planning
Why doctors talk about MGMT
MGMT methylation is a tumour marker that helps predict how likely temozolomide is to be effective. It does not make decisions on its own, but it helps guide the balance between benefit and side effects.
Treatment goals in this setting
When surgery is not possible, treatment goals usually focus on:
• preserving function and independence for as long as possible
• reducing symptoms and hospital admissions
• slowing tumour progression
Key takeaway
When glioblastoma cannot be safely removed surgically, treatment focuses on radiotherapy, carefully selected chemotherapy, and strong supportive care.
The aim is not only tumour control, but also preserving quality of life, function, and dignity throughout treatment.