| Recurrent glioblastoma (rGBM) is characterized by a high incidence and high mortality. The choice of treatment after recurrence is particularly important. Clinicians should consider multimodal treatment strategies based on the patient's clinical status, tumor characteristics, and tumor molecular/case features. Repeat surgery remains the first choice and can significantly prolong overall survival, especially for patients with localized recurrence and good physical condition, but it cannot eliminate tumor cells at the infiltrative margins. Re-irradiation is particularly suitable for patients who are not suitable for repeat surgery or who have residual tumors after surgery. In salvage chemotherapy, lomustine, temozolomide, and regorafenib are commonly used options. Although bevacizumab does not extend overall survival, it improves progression-free survival and quality of life. In innovative local physical therapies, tumor treating fields interfere with mitosis through alternating electric fields and can synergize with radiotherapy and chemotherapy; laser interstitial thermal therapy not only ablates tumors but also induces anti-tumor immunity; focused ultrasound can temporarily and reversibly open the blood-brain barrier, increasing the concentration of chemotherapy drugs several-fold and has immune-modulating effects. Immunotherapy shows promise through neoadjuvant administration, combination with radiotherapy, or local delivery. In the future, customized personalized plans based on the patient's genes, tumor molecular phenotypes, immune status, and other factors, along with the development and application of drugs tailored to different rGBM subtypes, will provide new avenues for rGBM patients. |
