Phase II Trial of Neo-adjuvant Temozolomide Prior to Combined Temozolomide and Concurrent Accelerated Hypofractionated External Beam Radiotherapy Followed by Adjuvant Temozolomide in Patients With Newly Diagnosed Glioblastoma Multiforme

Inclusion Criteria:

* Age: 18 years or older
* Histological confirmation of supratentorial GBM
* KPS \> 60
* Neurological function 0 or 1
* Adequate bone marrow as defined below:
* absolute neutrophil count (ANC) \> 1500 cells/mm3
* platelets \> 100,000 cells/mm3
* hemoglobin \> 10g/dl
* Adequate renal function as defined below:
* BUN \< 25mg/dl within 14 days prior to study registration
* creatinine of 63 to 103 umol/L within 14 days prior to study registration
* Adequate hepatic function as defined below:
* Bilirubin of 3 to 21 umol/L within 14 days prior to study registration
* ALT \& AST \< 3xnormal range within 14 days prior to study registration
* Neoadjuvant TMZ to start within 3 weeks of surgery/biopsy if no resection was deemed feasible
* A diagnostic contrast-enhanced MRI or CT scan of the brain must be performed preoperatively and postoperatively.
* History, physical and neurological examination within 14 days prior to study registration.
* For females of child-bearing potential, negative pregnancy test within 72 hours prior to starting TMZ.
* Able to sign an informed study-specific consent

Exclusion Criteria:

* Margin of contrast-enhanced residual mass closer than 15mm from the optic chiasm or optic nerves.
* Prior invasive malignancy, unless disease-free for \>3years
* Recurrent or multifocal GBM
* Severe co-morbidities such as
* unstable angina
* transmural myocardial infarction within 6 months
* COPD at the time of registration
* Hepatic insufficiency
* Bacterial or fungal infection requiring IV antibiotics at the time of registration
* Acquired Immune Deficiency Syndrome (AIDS)
* Major medical illnesses or psychiatric impairments
* Pregnant women or lactating women