Guideline

. 2025 Apr 1;32(4):207.

doi: 10.3390/curroncol32040207.

Canadian Expert Consensus Recommendations for the Diagnosis and Management of Glioblastoma: Results of a Delphi Study

Warren P Mason¹, Rebecca A Harrison², Sarah Lapointe^{3

4}, Mary Jane Lim-Fat⁵, Mary V MacNeil^{6

7}, David Mathieu⁸, James R Perry^{9

10}, Marshall W Pitz^{11

12}, David Roberge^{13

14}, Derek S Tsang¹⁵, Christina Tsien¹⁶, Frank K H van Landeghem¹⁷, Gelareh Zadeh^{18

19}, Jacob Easaw²⁰

Affiliations

¹ Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada.
² Department of Medicine, University of British Columbia, Vancouver, BC V5Z 4E6, Canada.
³ Department of Medicine, Centre Hospitalier Universitaire de Montreal, Montreal, QC H2X 3J4, Canada.
⁴ Faculty of Neuroscience, University of Montreal, Montreal, QC H3T 1J4, Canada.
⁵ Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
⁶ Department of Medicine, Dalhousie University, QE II Health Science Centre, Halifax, NS B3H 2Y9, Canada.
⁷ Department of Medicine, Nova Scotia Cancer Care, Halifax, NS B3H 1V8, Canada.
⁸ Department of Surgery, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
⁹ Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
¹⁰ Department of Medicine, University of Toronto, Toronto, ON M5S 1A4, Canada.
¹¹ Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 0V9, Canada.
¹² Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada.
¹³ Division of Radiation Oncology, Centre Hospitalier Universitaire de Montreal, Montreal, QC H2X 0C1, Canada.
¹⁴ Department of Radiology, Radiation-Oncology and Nuclear Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada.
¹⁵ Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada.
¹⁶ Department of Radiation Oncology, McGill University, Montreal, QC H4A 3J1, Canada.
¹⁷ Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada.
¹⁸ Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada.
¹⁹ Krembil Brain Institute, University Health Network, Toronto, ON M5T 1M8, Canada.
²⁰ Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada.

PMID: 40277764
PMCID: PMC12026134
DOI: 10.3390/curroncol32040207

Guideline

Canadian Expert Consensus Recommendations for the Diagnosis and Management of Glioblastoma: Results of a Delphi Study

Warren P Mason et al. Curr Oncol. 2025.

. 2025 Apr 1;32(4):207.

doi: 10.3390/curroncol32040207.

Authors

Affiliations

¹ Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada.
² Department of Medicine, University of British Columbia, Vancouver, BC V5Z 4E6, Canada.
³ Department of Medicine, Centre Hospitalier Universitaire de Montreal, Montreal, QC H2X 3J4, Canada.
⁴ Faculty of Neuroscience, University of Montreal, Montreal, QC H3T 1J4, Canada.
⁵ Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
⁶ Department of Medicine, Dalhousie University, QE II Health Science Centre, Halifax, NS B3H 2Y9, Canada.
⁷ Department of Medicine, Nova Scotia Cancer Care, Halifax, NS B3H 1V8, Canada.
⁸ Department of Surgery, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
⁹ Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
¹⁰ Department of Medicine, University of Toronto, Toronto, ON M5S 1A4, Canada.
¹¹ Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 0V9, Canada.
¹² Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada.
¹³ Division of Radiation Oncology, Centre Hospitalier Universitaire de Montreal, Montreal, QC H2X 0C1, Canada.
¹⁴ Department of Radiology, Radiation-Oncology and Nuclear Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada.
¹⁵ Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada.
¹⁶ Department of Radiation Oncology, McGill University, Montreal, QC H4A 3J1, Canada.
¹⁷ Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada.
¹⁸ Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada.
¹⁹ Krembil Brain Institute, University Health Network, Toronto, ON M5T 1M8, Canada.
²⁰ Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada.

PMID: 40277764
PMCID: PMC12026134
DOI: 10.3390/curroncol32040207

Abstract

Glioblastoma is the most common and aggressive malignant brain tumor in adults, with an increasing incidence and a poor prognosis. Current challenges in glioblastoma management include rapid tumor growth, limited treatment effectiveness, high recurrence rates, and a significant impact on patients' quality of life. Given the complexity of glioblastoma care and recent advancements in diagnostic and treatment modalities, updated guidelines are needed in Canada. This Delphi study aimed to develop Canadian consensus recommendations for the diagnosis, classification, and management of newly diagnosed and recurrent glioblastoma. A multidisciplinary panel of 14 Canadian experts in glioblastoma care was convened, and a comprehensive literature review was conducted to synthesize evidence and formulate initial recommendations. Consensus was achieved through three Delphi rounds, in which panelists rated their agreement with recommendation statements on a five-point Likert scale. Statements with ≥75% agreement were accepted, and others were revised for re-voting. Final recommendations were formulated based on the consensus level, strength of evidence, clinical expertise, and consideration of the Canadian healthcare context. These recommendations aim to standardize glioblastoma diagnosis and classification across Canada, provide evidence-based guidance for optimal treatment selection, integrate novel therapies, and enhance the overall quality of care for glioblastoma patients.

Keywords: diagnosis; glioblastoma; immunotherapy; management; molecular markers; targeted therapy; tumor-treating fields.

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Conflict of interest statement

Novocure provided honoraria to enable the authors, Warren P. Mason, Marshall W. Pitz, Rebecca A. Harrison, Mary V. MacNeil, James R. Perry, Mary Jane Lim-Fat, Frank K. H. van Landeghem, David Mathieu, Gelareh Zadeh, Sarah Lapointe, David Roberge, Derek S. Tsang, and Jacob Easaw, to meet and supported STA Healthcare Communications for logistical assistance with the Delphi process and medical writing for the manuscript. The funders played no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. In addition, the authors declare the following conflicts of interest: Warren P. Mason received grants, consulting fees, and honoraria for academic lectures from Novocure and Servier, as well as consulting fees from Boehringer Ingelheim, and participated on advisory boards for Boehringer Ingelheim, Novocure, Ono Therapeutics, and Servier. Marshall W. Pitz received grants from Novartis and Varian, consulting fees from Servier, and honoraria for academic lectures from Novartis and Servier. Rebecca A. Harrison received consulting fees from Servier Canada, as well as honoraria for academic lectures from EMD Serono, Pfizer, and Servier Canada, and held a role at the Brain Tumor Foundation of Canada. Mary V. MacNeil has no additional conflicts of interest to declare. James R. Perry received consulting fees from Novocure, NuVox, and Servier, honoraria for academic lectures and support for attending meetings from Servier Canada, and stocks from Synaptive Medical; moreover, James R. Perry participated in advisory boards for Novocure and Servier and held a role at the Global Coalition for Adaptive Research, the Canadian Brain Tumor Consortium, and the Society for Neuro-oncology. Mary Jane Lim-Fat received honoraria for academic lectures from Novocure and Servier. Frank K. H. van Landeghem received payment for expert testimony from the Office of the Chief Medical Examiner and holds a role at the Canadian Association of Neuropathologists. David Mathieu received consulting fees from Medexus and Servier and stock options from EncephalX and MedScint. Gelareh Zadeh has no additional conflicts of interest to declare. Sarah Lapointe received consulting fees from Alexion, Bayer, and Novocure, as well as honoraria for academic lectures from Servier, and participated on advisory boards for Servier. David Roberge received grants from Precirix, honoraria for academic lectures from AstraZeneca, Novartis, Recordati, and Roche Canada, payment for expert testimony from CNESST, support for attending meetings from IntraOp Medical, and stocks from AFX Medical, Croton Healthcare, and Miso Chip; moreover, Roberge participated in an advisory board for Novocure and held a role at the Canadian Association of Radiation Oncology and the Canadian Cancer Trials Group. Derek S. Tsang received grants from the National Cancer Institute and consulting fees and stock from Need (https://www.getneed.com). Christina Tsien received honoraria for academic lectures from Servier and Varian and support for attending meetings from Zeiss; additionally, Christina Tsien participated on advisory boards for Novocure and held a role at the ASTRO Diffuse WH Gr 4 Guideline Committee. Jacob Easaw received consulting fees from Novocure.

Figures

**Figure 1**
Flowchart of the Delphi consensus process.

**Figure 2**
Recommendations for the diagnosis and management of glioblastoma.

See this image and copyright information in PMC

References

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Canadian Expert Consensus Recommendations for the Diagnosis and Management of Glioblastoma: Results of a Delphi Study

Affiliations

Canadian Expert Consensus Recommendations for the Diagnosis and Management of Glioblastoma: Results of a Delphi Study

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Grants and funding

LinkOut - more resources

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Medical