Background: Current standard of care for newly diagnosed GBM includes trimodality treatment followed by six cycles of adjuvant temozolomide (TMZ). We analysed the uptake of standard of care in a real-world setting, and compared outcome to updated controlled clinical trial data. Methods: All GBM patients registered with Cancer Care Ontario between 2004-2008 were identified. Those who were >= 16 years age, newly diagnosed, treated at our institution, had confirmed pathology, complete records and imaging,were included. Demographics, planned and delivered treatments, total cycles of adjuvant TMZ, toxicity and outcome were captured. For survival analysis patients were stratified by age, ECOG, and treatment modalities, including total cycles of TMZ delivered. Descriptive statistics were used for early progressors and long term survivors. Kaplan-Meier curves, log-rank test and Cox proportional hazards model were used for survival analyses. To compare outcome from our population database to published data from controlled clinical trials, patients were stratified into radiotherapy (RT) only group or concurrent chemoradiation (CRT) followed by TMZ. At a median follow-up of 28 months, we compared our outcome data to updated EORTC 22981/26981 NCIC CE. 3 results. Results: 517 patients were identified and 433 included for analysis. Majority were male (63%), ECOG 0-1 (66%), and <=65 years(55%). 44% received CRT followed by TMZ, 13% had CRT only, 30% had RT only and 13% had best supportive care. 35% had >6 cycles of TMZ, 10% were early progressors (<3 months from completing CRT) and 9% survived beyond 2 years. In the entire cohort poor ECOG or older age demonstrated inferior survival (p<0.0001, p=0.0003 respectively). In a multivariate analysis CRT followed by TMZ predicted superior survival (p<0.0001). Comparison of our results to EORTC 22981/26981 NCIC CE. 3 data showed median survival was 15.8 months vs. 14.6 months, 2 year survival rate for CRT plus TMZ was 35% vs. 26%, and for RT alone 0% vs. 10%, respectively. Conclusions: Our results show that only < 50% of GBM patients complete standard of care in the real-world setting and prognosis remains dismal for patients who do not receive CRT.