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We synthesized reported progression-location involvement after upfront radiotherapy\/temozolomide (RT\/TMZ) and salvage therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched PubMed and Scopus from January 1, 2000, to February 1, 2026, and performed arm-level random-effects meta-analysis of logit-transformed proportions. Enhancing progression was harmonized as non-mutually exclusive local\/in-field, marginal\/field-edge, and distant\/out-of-field involvement among evaluable cases, using each study\u2019s spatial framework. The supplementary broad escape-pattern construct was defined as reported progression beyond purely local\/in-field enhancing failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 107 studies (122 arms; 10,529 patients). At first progression after upfront RT\/TMZ\u2009\u00b1\u2009TTF, reported local\/in-field enhancing involvement among evaluable cases was 79.2% (95% CI 75.7\u201382.3; k\u2009=\u200994;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096,989; I\u00b2=84.8%), and distant\/out-of-field involvement was 16.9% (95% CI 14.3\u201319.9; k\u2009=\u200989;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096,493; I\u00b2=85.2%). After salvage therapy, local\/in-field involvement remained the majority pattern reported among evaluable cases (59.8%, 95% CI 52.8\u201366.4; k\u2009=\u200927;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,572; I\u00b2=80.5%), with distant\/out-of-field involvement of 17.5% (95% CI 12.9\u201323.3; k\u2009=\u200921;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,307; I\u00b2=75.5%) and a supplementary broad escape-pattern estimate of 38.6% (95% CI 31.9\u201345.9; k\u2009=\u200927;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,572; I\u00b2=80.1%). Non-enhancing\/FLAIR-dominant progression was sparsely and likely selectively reported; only six recurrent\/salvage arms contributed data, yielding an exploratory pooled estimate of 27.8% (95% CI 12.8\u201350.3;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009216; I\u00b2=75.7%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Published GBM cohorts show predominantly local\/in-field enhancing progression after upfront therapy (~\u200980%) and persistent majority local\/in-field involvement after salvage therapy (~\u200960%). Standardized reporting of enhancing, non-enhancing\/FLAIR-dominant, disseminated, posterior fossa, and brainstem progression is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-026-05734-w","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:50:57Z","timestamp":1785405057000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Spatial patterns of progression in reported glioblastoma cohorts after upfront chemoradiation and salvage therapy: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"179","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7644-3444","authenticated-orcid":false,"given":"Rafal","family":"Chojak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah B.","family":"Drewes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Slychan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rimas V.","family":"Lukas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"5734_CR1","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1056\/NEJMoa043330","volume":"352","author":"R Stupp","year":"2005","unstructured":"Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJB et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. 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