Adult IDH-wildtype glioblastoma in Mexico and Latin America: contemporary standards, emerging strategies, and an evidence-to-implementation roadmap

Glioblastoma remains a major therapeutic challenge, and disparities in diagnostic capacity, treatment access, and continuity of care may further limit outcomes in Mexico and Latin America. This structured narrative review examines contemporary management of glioblastoma in adults, focusing on implementation of evidence-based care across resource-variable health systems. We reviewed literature published from 2005 through August 2026, including guidelines, consensus statements, randomized trials, prospective and registry-based studies, systematic reviews, meta-analyses, regional cohorts, epidemiological data, and health-system evidence. Current evidence supports integrated molecular diagnosis, maximal safe resection, postoperative radiotherapy with temozolomide, individualized management at recurrence, and early supportive and palliative care. Molecular classification and standardized imaging are essential to treatment selection and response assessment, whereas emerging targeted, immune, cellular, DNA-damage response, blood–brain barrier, and artificial intelligence approaches remain dependent on indication-specific evidence and appropriate clinical-trial or specialist oversight. Contemporary epidemiological and real-world studies provide external survival benchmarks, although differences in molecular classification, population selection, and study design limit direct comparisons with regional estimates and clinical-trial outcomes. Regional studies identify gaps in molecular testing, radiotherapy access, treatment continuity, and socioeconomic and geographic equity; however, evidence remains concentrated in a limited number of countries and tertiary centers, limiting its representativeness across Latin America. We propose a conceptual, resource-stratified, bidirectional local-to-hub framework in which routine care remains local when quality standards can be met, while specialist centers provide complex diagnostics, procedures, treatment review, recurrence assessment, and research access. Shared infrastructure for remote review, specimen and data transfer, patient navigation, and prospective quality measurement may reduce avoidable barriers without lowering clinical standards. The framework distinguishes established care from specialist-supported and investigational strategies and proposes indicators to evaluate diagnostic timeliness, treatment completion, referral performance, supportive care, equity, and research access. Improving outcomes requires not only access to effective therapies, but reliable systems capable of delivering them consistently and equitably throughout the course of disease.