As treatment response can mimic progressive tumor on standard imaging, clinical outcomes following upfront chemo-radiotherapy in newly diagnosed glioblastoma rely heavily on MGMT promoter methylation status. While MGMT is a reliable marker of outcomes, the purpose of this study was to determine if inclusion of advanced perfusion-MRI derived fractional tumor burden (FTB) volume might better inform survival outcomes. Results revealed that low FTB volume in MGMT unmethylated glioblastoma confers significant survival benefit, approaching that of MGMT methylated glioblastoma. Clinically, combining FTB with MGMT methylation status may identify patients with potentially better outcomes or for whom more aggressive approaches are warranted.
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