Background: The Project of Emilia Romagna in Neuro-Oncology (PERNO) is a prospective registry and it was created to evaluate the incidence and treatment of primary brain tumors (PBTs) in this italian region. In this network, as a subproject, a population-based prospective study was conducted to assess the survival outcome of glioblastoma (GBM) patients, and correlations with potential prognostic factors. Methods: Based on the data from this registry, from January 1^st 2009 to December 31^st 2010, a prospective study was made of the treatment efficacy and outcome in newly diagnosed GBM patients £70 years treated with the worldwide accepted standard treatment according to the EORTC 22981/26981) /NCIC CE.3 trial (temozolomide concomitant with and adjuvant to radiotherapy - RT/TMZ). Results: 267 GBM patients were enrolled, 139 patients were £70 years and received RT/TMZ, achieving a median overall survival (OS) of 16.4 months (95%CI: 14.0–18.5). At multivariate analysis, OS was significantly correlated with KPS (HR=0.458, 95%CI: 0.248-0.847, p=0.0127), MGMT methylation status (HR=0.612, 95%CI: 0.388-0.966, p=0.0350) and if treatment was received in the high volume center (HR=0.569, 95%CI: 0.328-0.986, p=0.0446). Median overall survival was 24.1 months for patients treated in the referral high volume center and 15.9 months in other centers (HR: 0.533, 95% CI: 0.328 – 0.866, p=0.0110), with no significant differences in KPS and MGMT methylation status among the centers. Conclusions: For the first time in the field of neuro-oncology, we have investigated the impact of center volume and expertise in post-surgical treatment, as a variable that may influence the outcome of GBM patients < 70 years and treated with RT/TMZ. Our findings may have depended on several factors, such as expertise in neuroradiology interpretation as well as the management of adverse events, and the use of third line treatments or the best supportive care. The amount of OS improvement supports further investigation of center volume and expertise as a prognostic factor.