Introduction

Glioblastoma (GB) remains the most devastating primary malignancy of the central nervous system. Despite decades of multimodal treatment consisting of surgical resection followed by the standard Stupp protocol of adjuvant temozolomide (TMZ)-based chemoradiotherapy, survival has historically stagnated, with a median overall survival (OS) of 12-15 months in controlled clinical trials [1].

In Latin American healthcare systems, translating these protocols into real-world practice often exposes profound challenges to therapeutic equity. Uruguay established a pioneering regional policy through its National Resource Fund (Fondo Nacional de Recursos [FNR]), which has guaranteed universal public funding for oral TMZ since 2009 [2]. This policy aimed to eliminate financial toxicity and ensure equitable access to the standard of care.

The objective of this study was to perform a comprehensive survival analysis of patients with hemispheric GB treated at the Neuro-Oncology Unit at the Hospital de Clínicas “Dr. Manuel Quintela” in Montevideo, Uruguay, between 2009 and 2017 [3]. By establishing this long-term statistical baseline, we aimed to provide the real-world evidence necessary to evaluate the impact of historical public coverage - a prerequisite for regional health systems planning the future integration of emerging, ultra-high-cost biological therapies.