Functional Recovery After Severe Postoperative Decline in Glioblastoma: The Importance of Reassessing Treatment Eligibility

Glioblastoma is the most common and aggressive primary malignant brain tumor in adults, and those arising in the frontal lobe can present with subtle cognitive and behavioral changes, often delaying diagnosis.We present a case of a 67-year-old male patient who presented with a two-week history of psychomotor slowing and progressive difficulty expressing himself, initially concerning for aphasia.Neurological examination suggested a frontal lobe syndrome rather than a true aphasic disorder.Magnetic resonance imaging (MRI) demonstrated a 4.4×3.2×3.8 cm left frontal mass with peripheral enhancement, central necrosis, and extensive vasogenic edema.He underwent left frontal craniotomy with radiologically complete resection; histopathology confirmed isocitrate dehydrogenase (IDH)-wildtype glioblastoma, central nervous system (CNS) World Health Organization (WHO) grade 4. The patient's postoperative course was complicated by a new intraparenchymal hematoma and parafalcine subarachnoid hemorrhage.Three weeks after surgery, his Karnofsky performance status (KPS) was 40%, initially raising doubts about his candidacy for chemotherapy.He subsequently improved clinically, allowing initiation of hypofractionated radiotherapy (40 Gy in 15 fractions) with concurrent temozolomide, followed by all six planned cycles of adjuvant temozolomide, complicated by fluctuating thrombocytopenia with one asymptomatic nadir of 37,000/µL.Surveillance MRI approximately nine months after surgery showed no evidence of viable tumor recurrence.This case highlights that a severely reduced early postoperative performance status in glioblastoma does not necessarily preclude completion of standard multimodal therapy, and underscores the importance of reassessing functional status and excluding reversible complications, such as postoperative hemorrhage, before treatment is withheld.