Stupp protocol for glioblastoma

Last revised by Assoc Prof Frank Gaillard on 02 May 2022

The Stupp protocol has become the standard of care for the treatment of glioblastoma since its publication in 2005 and has led to significant survival improvements 1. It consists of radiotherapy and concomitant chemotherapy with temozolomide, an alkylating agent.

According to the original study, the Stupp protocol comprises: 

  • radiotherapy
    • total 60 Gy
    • 2 Gy per daily fraction (Monday to Friday) over 6 weeks
  • temozolomide
    • during radiotherapy: 75 mg per square meter of body-surface area per day, 7 days per week
    • post-radiotherapy (adjuvant): six cycles consisting of 150-200 mg per square meter for 5 days during each 28-day cycle

This therapy resulted in a significant survival improvement at 2 years: 

  • 26.5% 2-year-survival with Stupp protocol
  • 10.4% 2-year-survival with radiotherapy alone

A substantial minority of patients can demonstrate changes of pseudoprogression on follow up imaging. 

The Stupp protocol is named after Roger Stupp the first author of the 2005 paper, who is a Swiss oncologist from the University of Zürich 1

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