Glioblastoma treatment patterns and outcomes over 18 years in an Irish cancer centre.

Glioblastoma is the most common malignant brain tumour in adults and carries a poor prognosis despite advances in molecular characterisation and therapy. The 2021 World Health Organisation classification redefined glioblastoma as an IDH-wildtype diffuse astrocytic tumour with aggressive histological or molecular features. Standard of care therapy has changed little over the last two decades, and outcomes remain suboptimal, with considerable heterogeneity in survival influenced by clinical, molecular, and treatment-related factors. This study evaluates the clinical and molecular characteristics, treatment strategies, and survival outcomes for glioblastoma patients at Cork University Hospital from 2006-2023 to assess changes in management and outcomes. 494 patients were diagnosed with glioblastoma between 1st of January 2006 and 31st of December 2023. IDH mutant cases were excluded. Data was extracted from medical records, with survival analyses using the Kaplan-Meier method and COX proportional hazards model. The median age was 63 years (range: 17-86). Increased availability of molecular markers was observed between the time periods. Median overall survival remained stable over time (2006-2010: 9.9 months; 2011-2014: 11.9 months; 2015-2019: 10.9 months; 2020-2023: 11.1 months), with no statistical significance between periods. On multivariate analysis, key prognostic factors included age at diagnosis, ECOG performance status, glucocorticoid use at baseline, MGMT methylation status, and completion of the adjuvant chemo-radiation. Despite advances in our understanding of the pathogenesis of glioblastoma, the mOS median overall survival in our real-world patient cohort did not improve over time. The findings emphasise the need for ongoing research efforts to improve outcomes in this lethal disease.