Clinical Scorecard: Survival Outcomes for Glioblastoma in Rural America: Insights from a Decade of Experience at a Quaternary Care Facility
At a Glance
Category
Detail
Condition
Glioblastoma (GBM), IDH-wildtype
Key Mechanisms
Maximal safe resection, radiotherapy (60 Gy in 30 fractions), concurrent and adjuvant temozolomide (TMZ)
Target Population
Adults (≥18 years) with pathologically confirmed IDH-WT GBM
Care Setting
Quaternary care neuro-oncology referral center (WVU Ruby Memorial Hospital)
Key Highlights
GBM is the most common and lethal primary malignant brain tumor in adults with median overall survival (mOS) ~14.6 months in trials but 10–13 months in real-world cohorts.
Rural patients face barriers including travel distance, delayed referral, and lower treatment adherence, impacting survival.
Centralized multidisciplinary neuro-oncology care with uniform treatment use may mitigate rural-urban survival disparities.
Guideline-Based Recommendations
Diagnosis
Pathological confirmation of IDH-wildtype GBM with molecular workup.
Use of ICD-10 code C71 for malignant brain neoplasm identification.
Classification of rural residence using ZIP-code-level RUCA codes.
Management
Maximal safe surgical resection when feasible to improve overall survival by 3–6 months.
Radiotherapy at 60 Gy in 30 fractions combined with concurrent temozolomide (75 mg/m² daily).
Six cycles of adjuvant temozolomide (150–200 mg/m²).
Ensure completion of multimodal therapy to optimize outcomes.
Monitoring & Follow-up
Longitudinal follow-up at specialized neuro-oncology centers.
Use of Kaplan–Meier survival estimates and Cox proportional hazards models for outcome assessment.
Risks
Omission of temozolomide or radiation independently worsens prognosis.
Sociodemographic and geographic barriers may lead to treatment delays and incomplete therapy.
Rural residence associated with increased mortality risk in brain/CNS cancers.
Patient & Prescribing Data
380 adults with pathologically confirmed IDH-WT GBM treated at WVU Ruby Memorial Hospital from 2015 to 2025.
66.8% received temozolomide, 88.4% underwent surgical resection, and 59.5% received radiation therapy, reflecting adherence to standard-of-care protocols.
Clinical Best Practices
Centralize neuro-oncology care to ensure standardized diagnostic workup and treatment planning.
Promote maximal safe resection combined with chemoradiation to improve survival.
Address geographic and sociodemographic barriers to facilitate timely treatment initiation and completion.
Utilize molecular classification to guide prognosis and management.
Implement robust data collection and geospatial analysis to monitor rural-urban disparities.
