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Health condition · Clinically reviewed

Glioblastoma, the WHO grade 4 brain tumour - and how it is treated in the UK today.

The most common and most aggressive primary brain tumour in adults. Molecular profiling, maximal safe surgery and the Stupp protocol now sit at the heart of care.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG99, EANO and peer-reviewed neuro-oncology sources.

  • 03

    Current for 2026

    Reflects the WHO 2021 classification, Stupp protocol updates and current UK specialist commissioning.

Key facts

Glioblastoma at a glance.

The essentials in plain English - what glioblastoma is, how it is classified, and how it is treated in the UK today.

  • What it is

    Glioblastoma (GBM) is the most common and most aggressive primary brain tumour in adults, arising from astrocytic glial cells.

  • WHO 2021 grading

    Grade 4 astrocytoma IDH-wildtype (the majority of GBM) or grade 4 astrocytoma IDH-mutant, which carries a better prognosis.

  • Who it affects

    Peak incidence between 55 and 75 years. Slightly more common in men than women. Rare in children.

  • Prognosis

    Median survival 12 to 15 months with maximal therapy. Five-year survival is around 5 to 10 per cent and gradually improving.

  • Molecular markers

    MGMT promoter methylation, IDH1/2, TERT promoter, 1p/19q, EGFR amplification, PTEN loss and ATRX status all shape treatment.

  • First-line care

    Maximal safe surgical resection followed by concurrent chemoradiotherapy (Stupp protocol) with temozolomide.

Why this guide matters

A modern GBM plan is molecular, surgical and multidisciplinary.

Care has changed. WHO 2021 reclassification, integrated molecular diagnosis and the Stupp protocol together shape everything else on this page.

  • Molecular profiling changes everything

    IDH status, MGMT methylation and other markers now define subtype and prognosis. Every glioblastoma needs integrated diagnosis under WHO 2021.

  • Maximal safe resection sets the ceiling

    The extent of safe surgical resection is one of the strongest modifiable prognostic factors. 5-ALA fluorescence and intraoperative MRI help push it further.

  • The Stupp protocol is the backbone

    Radiotherapy with concurrent and adjuvant temozolomide remains the standard first-line care, especially in MGMT-methylated tumours.

How the diagnosis is made

From first symptoms to an integrated diagnosis.

The steps a UK neurosurgical and neuro-oncology team will normally follow, so you know what to expect and why.

  1. 01

    Assessing

    Clinical assessment and history

    A structured neurological review focused on subacute headache, focal deficits, seizures and any cognitive or personality change.

  2. 02

    Assessing

    Urgent MRI brain with gadolinium

    The gold-standard first investigation. Typical features are a contrast-enhancing mass with central necrosis and peritumoural oedema.

  3. 03

    Assessing

    Advanced MRI sequences

    MR spectroscopy, perfusion imaging and diffusion tensor imaging (DTI) help differentiate high-grade glioma from mimics. Specialist commissioned.

  4. 04

    Confirming

    Neuro-oncology MDT referral

    Every suspected high-grade glioma is discussed at a specialist neuro-oncology MDT at a commissioned centre such as Queen Square, King’s, Cambridge or Manchester.

  5. 05

    Confirming

    Tissue biopsy and neuropathology

    Stereotactic or open biopsy provides tissue for specialist neuropathology and integrated molecular diagnosis under WHO 2021.

  6. 06

    Preparing

    Molecular profiling

    IDH1/2, MGMT promoter methylation, TERT, EGFR, 1p/19q, ATRX and p53 testing shape both prognosis and treatment choice.

  7. 07

    Preparing

    Functional and surgical planning

    Functional MRI, the Wada test and awake craniotomy planning are used when the tumour sits near eloquent cortex. Specialist commissioned.

Typical timeline: from first MRI to specialist MDT and surgery within days to a few weeks.

Symptoms

What glioblastoma actually looks like.

Symptoms often build over weeks and reflect where the tumour sits. Anatomy predicts pattern, but rapid change is the common thread.

  • Progressive headache

    Often worse in the morning or on Valsalva. Reflects raised intracranial pressure and peritumoural oedema.

  • Focal neurological deficit

    Weakness, sensory change, dysphasia, visual field loss or coordination problems depending on tumour location.

  • New-onset seizures

    Around 30 to 50 per cent present with seizures. Focal or generalised, often the first clue to an underlying lesion.

  • Cognitive and behavioural change

    Slowed thinking, memory loss, personality change or apathy. Frequently noticed by family before the patient.

  • Rapid clinical progression

    Symptoms typically evolve over weeks rather than months. Median interval to diagnosis is around 3 months.

  • Nausea and vomiting

    A sign of raised intracranial pressure. Often accompanies morning headache and papilloedema.

  • Visual disturbance

    Blurred vision, diplopia or homonymous field defects depending on the location of the tumour.

  • Red flag - reduced consciousness

    Drowsiness, confusion or a rapid drop in GCS is a neurosurgical emergency and needs the same-day acute pathway.

Treatment

How glioblastoma is treated in the UK.

Maximal safe resection first, then the Stupp protocol, with molecular-guided second-line options at recurrence and access to trials.

  • Maximal safe resection

    Specialist neurosurgery with intraoperative MRI, 5-ALA fluorescence-guided resection and, when needed, awake craniotomy. See our guide on awake craniotomy for brain tumour.

  • Stupp protocol

    Concurrent radiotherapy (60 Gy over 6 weeks) with daily temozolomide, followed by six cycles of adjuvant temozolomide. Standard first-line care.

  • Lomustine plus temozolomide

    The CeTeg regimen for MGMT-methylated GBM, delivered in specialist neuro-oncology centres for suitable, fitter patients.

  • Tumour-treating fields (Optune)

    Wearable device delivering alternating electric fields. FDA-approved and used privately in the UK. Not currently NHS-funded.

  • Reduced-dose radiotherapy

    Hypofractionated regimens for older or frail patients where the full 6-week Stupp course is not appropriate.

  • Bevacizumab and second-line

    Anti-VEGF therapy at recurrence, alongside lomustine, regorafenib, re-resection, reirradiation or clinical trials. Specialist commissioned.

  • Molecular-targeted therapy

    BRAF V600E-mutant GBM may respond to BRAF and MEK inhibitors. Access is specialist and molecularly guided.

  • Supportive and palliative care

    Dexamethasone for oedema, antiepileptics for seizures, PPI and PJP prophylaxis, plus early specialist palliative and hospice input.

What this guide is based on

The sources behind every claim on this page.

UK and international neuro-oncology guidance and the trial evidence that underpins the Stupp protocol.

Key references

Guidelines and trial evidence we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your neuro-oncology team knows your imaging, molecular results and general health. They can tell you which parts of this guide apply to your situation.

  • NICE. Brain tumours (primary) and brain metastases in adults (NG99).

  • European Association of Neuro-Oncology (EANO). Guidelines on the diagnosis and treatment of adult glioma.

  • WHO Classification of Tumours of the Central Nervous System, 5th edition (2021).

  • Stupp R et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. NEJM.

  • The Brain Tumour Charity and Brain Tumour Research. Patient information and support.

Red flags

When glioblastoma needs urgent attention.

Some features cannot wait for the next scheduled clinic. These are the situations that need same-day neurosurgical or oncology input.

  • Reduced consciousness

    Drowsiness, confusion or a falling GCS suggests raised intracranial pressure and needs urgent neurosurgical assessment.

  • Status epilepticus

    Prolonged or repeated seizures without recovery are a medical emergency. Call 999 and treat as per UK status protocols.

  • Rapid focal deterioration

    A quickly worsening hemiparesis, dysphasia or visual loss warrants same-day neurosurgical review to exclude haemorrhage or herniation.

  • Severe morning headache with vomiting

    Classic features of raised intracranial pressure. Combined with papilloedema, this is an urgent imaging indication.

  • New seizure in an adult

    Any first seizure in an adult without a clear provoking cause requires urgent brain imaging to exclude a structural lesion.

  • Steroid-related complications

    Hyperglycaemia, mood change, myopathy and infection risk on dexamethasone. Review dose regularly and use PPI and PJP prophylaxis.

  • Venous thromboembolism

    GBM carries a high VTE risk. New leg swelling, breathlessness or chest pain needs urgent assessment.

  • Suspected recurrence

    New or worsening neurological symptoms after treatment need repeat MRI and specialist review, not a wait-and-see approach.

  • Psychological distress

    GBM is emotionally devastating for patients and families. Early psychological, palliative and charity support is essential.

Living with it

A serious diagnosis, with real support around it.

Four things make the biggest difference day to day: staying under specialist review, rehabilitation, using the charities and having the hard conversations early.

A quiet reminder

You are not doing this alone.

Neuro-oncology CNS teams, palliative care and charity nurses exist for exactly this. Ask early and often.

  1. 01 Team

    Stay under specialist review

    GBM care sits with a commissioned neuro-oncology MDT. Every treatment decision benefits from that combined expertise.

  2. 02 Function

    Rehabilitation matters

    Physiotherapy, occupational therapy and speech and language therapy protect function and independence after surgery.

  3. 03 Support

    Use the charities early

    The Brain Tumour Charity, Brain Tumour Research and Macmillan offer nurses, grants and peer support. Reach out at diagnosis, not later.

  4. 04 Planning

    Talk about what matters

    Advance care planning, driving, work and finances are hard conversations. Having them early keeps you in control.

Frequently asked

Everything we get asked about glioblastoma.

Quick answers on prognosis, molecular testing, the Stupp protocol, Optune and recurrence.

  • What is glioblastoma?

    Glioblastoma (GBM) is a grade 4 astrocytoma under the WHO 2021 classification. It is the most common and most aggressive primary brain tumour in adults, most often diagnosed between the ages of 55 and 75.

  • What is the prognosis for glioblastoma?

    Median survival with the Stupp protocol is around 12 to 15 months, and 5-year survival is roughly 5 to 10 per cent. IDH-mutant grade 4 astrocytoma and MGMT-methylated tumours generally do better, and outcomes are gradually improving with new therapies and trials.

  • Why does molecular testing matter?

    IDH status, MGMT promoter methylation, TERT, EGFR, 1p/19q and ATRX all change how the tumour behaves and how it responds to treatment. MGMT methylation, for example, is both prognostic and predictive for benefit from temozolomide.

  • What is the Stupp protocol?

    It is the standard first-line regimen for glioblastoma - maximal safe surgical resection followed by 60 Gy of radiotherapy over 6 weeks with concurrent daily temozolomide, then 6 cycles of adjuvant temozolomide. It doubles median survival compared with radiotherapy alone.

  • Are tumour-treating fields (Optune) available in the UK?

    Optune is FDA-approved and used with the Stupp protocol in some countries. In the UK it is not currently NHS-funded and is only accessible through private neuro-oncology providers. Our guide on tumour-treating fields explains how it works.

  • What happens if glioblastoma comes back?

    At recurrence, options include further surgery, lomustine, bevacizumab, regorafenib, reirradiation and clinical trials of immunotherapy, CAR-T or vaccines. Choices depend on prior treatment, performance status, molecular profile and patient preference. Every recurrence should be discussed at the neuro-oncology MDT.

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