Optimizing the Stupp protocol for treatment of glioblastoma: eliminating age bias, enhancing treatment timing, use of stereotactically-guided sequential boost, and dexamethasone dosing
By
Martyn A. Sharpe
Alexandra M. Baskin
Bin S. Teh
E. Brian Butler
David Stuart Baskin
July 3, 2026
Clinical Scorecard: Refining the Stupp Protocol for Glioblastoma Management: Addressing Age Disparities, Improving Treatment Timing, Implementing Stereotactic Sequential Boosts, and Adjusting Dexamethasone Administration
At a Glance
Category Detail
Condition Glioblastoma Key Mechanisms Stupp protocol, dexamethasone administration, SGS-Boost, adjuvant temozolomide Target Population Patients with glioblastoma, particularly those aged ≥ 70 years Care Setting Oncology and neurosurgery departments
Key Highlights
Age is a significant demographic factor affecting treatment provision of the Stupp protocol. Only 44% of fully resected patients aged ≥ 70 years received standard chemoradiotherapy. SGS-Boost may aid survival in glioblastoma patients. Dexamethasone levels impact outcomes and are administered at critical treatment intervals. Extending adjuvant temozolomide from 6 to 12 cycles may improve survival. Guideline-Based Recommendations
Diagnosis
Utilize 2021 WHO diagnostic criteria for glioblastoma. Management
Implement the Stupp protocol with consideration for age-related treatment disparities. Monitoring & Follow-up
Assess dexamethasone dosages at key treatment intervals. Risks
Consider the immunosuppressive effects of dexamethasone on outcomes. Patient & Prescribing Data
269 patients with glioblastoma meeting 2021 WHO criteria.
173 patients received the Stupp protocol; 152 initiated adjuvant temozolomide.
Clinical Best Practices
Maximal resection should be prioritized, especially in patients < 70 years. Careful monitoring of dexamethasone administration is essential to mitigate adverse effects. Related Resources & Content
