{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:50:13Z","timestamp":1792057813066,"version":"4.4.0"},"reference-count":47,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asia-Pac J Clncl Oncology"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the clinical and radiological outcomes of upfront temozolomide (TMZ) monotherapy in deferring radiotherapy for multifocal glioblastoma (GBM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 18 consecutive adult patients with newly diagnosed, multifocal GBM treated with upfront TMZ monotherapy between 2016 and 2024. The primary endpoint was a 6\u2010month progression\u2010free survival (PFS). Secondary endpoints were overall survival (OS) and radiological tumor response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age of the cohort was 69 years. The median follow\u2010up was 12 months. Thirteen (72.2%) patients had O\u2076\u2010methylguanine\u2010DNA methyltransferase\u00a0(MGMT)\u2010methylated tumors. Bi\u2010hemispheric disease was present in 16 patients (88.9%) at baseline. Patients received a median of six TMZ cycles. Disease relapse occurred in 94.4% (\n                      <jats:italic>n<\/jats:italic>\n                      = 17) of cases, with 47.0% of failures involving distant sites. The 6\u2010month PFS was 61% (95% CI: 42.3%\u201388.3%), and the median OS was 12.2 months (95% CI: 11.2\u201331.1). MGMT\u2010methylated tumors demonstrated a significant volumetric reduction at 3 months compared to unmethylated cases (median \u221234.2% vs. +114.0%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.007). Survival outcomes trended in favour of the methylated cohort (6\u2010month PFS 69.2%\u00a0vs.\u00a040.0%; median OS 12.3\u00a0vs.\u00a011.2 months), though these associations did not reach statistical significance (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.480).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides valuable insights into the use of primary TMZ as an exploratory strategy for short\u2010term modulation in highly selected patients with extensive multifocal GBM. Whilst this approach facilitates a strategic delay in large\u2010volume radiation, the high relapse rate underscores that upfront TMZ serves as a temporary window for deferring neurotoxicity rather than achieving durable disease control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ajco.70210","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:36:57Z","timestamp":1792057017000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multifocal Glioblastoma Managed With Primary Temozolomide as a Strategy to Delay Radiation Therapy: Clinical and Radiological Outcomes"],"prefix":"10.1111","author":[{"given":"Chun Khai","family":"Loh","sequence":"first","affiliation":[{"name":"Central Coast Cancer Centre Gosford Hospital  Gosford New South Wales Australia"},{"name":"University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Wheeler","sequence":"additional","affiliation":[{"name":"University of Sydney  Sydney New South Wales Australia"},{"name":"The Brain Cancer Group  Sydney New South Wales Australia"},{"name":"Northern Sydney Cancer Centre  St Leonards New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Lee","sequence":"additional","affiliation":[{"name":"The Brain Cancer Group  Sydney New South Wales Australia"},{"name":"Northern Sydney Cancer Centre  St Leonards New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Wong","sequence":"additional","affiliation":[{"name":"Central Coast Cancer Centre Gosford Hospital  Gosford New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malmaruha","family":"Arasaratnam","sequence":"additional","affiliation":[{"name":"Central Coast Cancer Centre Gosford Hospital  Gosford New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Cove","sequence":"additional","affiliation":[{"name":"Central Coast Cancer Centre Gosford Hospital  Gosford New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Kastelan","sequence":"additional","affiliation":[{"name":"The Brain Cancer Group  Sydney New South Wales Australia"},{"name":"Northern Sydney Cancer Centre  St Leonards New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Back","sequence":"additional","affiliation":[{"name":"Central Coast Cancer Centre Gosford Hospital  Gosford New South Wales Australia"},{"name":"University of Sydney  Sydney New South Wales Australia"},{"name":"The Brain Cancer Group  Sydney New South Wales Australia"},{"name":"Northern Sydney Cancer Centre  St Leonards New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Radiotherapy Plus Concomitant and Adjuvant Temozolomide for Glioblastoma","author":"Stupp R.","year":"2005"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401\u2010016\u20101545\u20101"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0708126"},{"issue":"11","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.3390\/cancers15112999","article-title":"Radiation\u2010Induced Brain Injury: Age Dependency of Neurocognitive Dysfunction Following Radiotherapy","volume":"15","author":"R\u00fcbe C. 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