Speed Matters: Fast Remote Assessment
Glioblastoma is a rapidly growing tumor, so for an international patient the most valuable step is a fast remote assessment that minimizes lost time. You can obtain an online opinion without delay by sharing your contrast-enhanced MRI and any biopsy/pathology and molecular results (IDH status, MGMT methylation) via WhatsApp. In this opinion, the tumor's features, the suitability of surgery and whether traveling to Turkey is meaningful for your situation are discussed honestly; if appropriate, the treatment process is planned quickly, also taking into account continuation treatment in your home country.
What Is Glioblastoma?
Glioblastoma is a high-grade tumor arising from the brain's supporting glial cells (particularly astrocytes) and is defined in the 2021 WHO classification as a grade 4 astrocytic tumor (IDH-wildtype). Microscopically it is characterized by marked cell proliferation, increased blood vessels and areas of necrosis. Because it infiltrates the surrounding brain with finger-like extensions, even when its border looks well defined on imaging it has spread microscopically; this explains why treatment cannot be limited to surgery. In a patient coming from abroad, the MRI at hand typically shows a ring-enhancing mass with central necrosis surrounded by extensive edema; the definitive diagnosis becomes clear with tissue and molecular analysis.
Surgery Alone Is Not Enough
The standard approach is the widest possible safe surgical resection followed by concurrent radiotherapy and temozolomide chemotherapy (the Stupp protocol). The aim of surgery is to reduce the tumor burden and provide a tissue diagnosis; however, because the tumor infiltrates microscopically, surgery alone does not provide a 'cure', and the subsequent treatments are essential. To perform the resection while preserving function, neuronavigation, functional mapping, awake craniotomy when needed and fluorescence-guided (5-ALA) techniques are used. For an international patient, the most important planning at this point is where the post-operative radiotherapy-chemotherapy will be continued: in Turkey or in your home country. This is discussed multidisciplinarily from the outset.
The Treatment Journey in Turkey
If surgery is found appropriate after the remote opinion, the date and estimated length of stay are planned quickly with speed in mind. On arriving in Turkey, an in-person neurological examination, contrast MRI and, when needed, functional MRI and DTI tractography are carried out; tumors near a functional area are operated awake when required. After surgery there is usually 24-48 hours of intensive care and a few days in hospital; the extent of resection is assessed with a control MRI. The radiotherapy-chemotherapy course usually begins within a few weeks; so that this can be coordinated with the oncology team in your home country, your pathology-molecular results and the recommended protocol are provided in writing.
Honest Expectation Management and Multilingual Communication
Glioblastoma is an aggressive tumor and, despite current treatment, its prognosis remains limited; saying this honestly is our responsibility as physicians. Molecular features such as MGMT promoter methylation can influence treatment response. Treatment often aims to control the disease, reduce symptoms and preserve quality of life as much as possible. The risks of surgery (bleeding, infection, a temporary/permanent deficit, edema, seizures) are discussed openly. For a patient and family coming from across a border, the most important point is that these difficult realities are clearly understood in their own language. We make no guaranteed promises; each patient's course is different, and expectations are shared openly from the start.