Real-World Treatment Pathways of Adult Patients with Glioblastoma and Other CNS Tumors: A Population-Based Registry Study

Background: Population-level evidence on delivery of neuro-oncology care is essential for evaluating access, equity, and quality of treatment pathways. However, real-world data describing how patients with central nervous system (CNS) tumors, especially with glioblastoma, are managed across healthcare systems remain limited. This study aimed to characterize treatment pathways using linked registry and administrative data within a regional care network. Methods: All adult CNS tumors diagnosed between 2016 and 2020 were identified in the Veneto Cancer Registry. Tumor grading was derived using a validated text-mining algorithm, and surgical, radiotherapy, and systemic treatments were captured through linkage with regional healthcare utilization databases. Patterns of care were evaluated by tumor subtype, grade, and diagnostic pathway. Results: Among 1,634 histologically confirmed tumors, glioblastoma represented the largest group. Surgical intervention was widely implemented, with high resection rates in glioblastoma and meningioma. Combined chemoradiotherapy constituted the primary adjuvant approach for glioblastoma and high-grade diffuse gliomas, whereas management of lower-grade tumors showed greater variability. Approximately one third of patients received no oncologic therapy, primarily associated with older age or diagnostic uncertainty. Analysis of recurrent glioblastoma showed heterogeneous systemic treatment use, reflecting evolving therapeutic practice. Conclusions: Linking population-based registry and administrative data provides actionable insight into real-world delivery of neuro-oncology care, in particular for glioblastoma patients. This approach enables monitoring of treatment variability, identification of potential access gaps, and evaluation of system-level performance, supporting data-driven planning of multidisciplinary services and future quality improvement initiatives.