These were both options I was not presented with, and in retrospect I would have liked the chance to discuss them. Two things are worth raising before surgery, as they depend on choices made during the operation:

Dendritic cell (DC) vaccines. These use your own immune cells and typically require tumour tissue to be preserved in a specific way during the resection surgery itself — so it's important to raise this in advance. In India, DenVax is one such dendritic cell vaccine option you can ask about.

5-ALA guided surgery. 5-ALA is a substance that makes tumour tissue fluoresce under special light during the operation, helping the surgeon distinguish tumour from healthy brain and achieve a more complete removal. Ask your neurosurgeon whether it's available and appropriate for your case.

If you're hoping to have children, raise this with your treating team straight away. Chemotherapy can affect fertility in both women and men, and options such as freezing eggs, embryos or sperm need to be explored in the short window — usually a few weeks — between surgery and the start of radiation.

I was not advised a separate biopsy — the tumour sample was taken during my surgery itself. In some cases, depending on the tumour's location, size, and other factors, a separate biopsy may be advised. You can check with your neurosurgeon on this.

It's worth asking your radiation oncologist about the choice between photon and proton radiotherapy, and which is more suitable for your situation.

These can range widely — from fatigue and severe acne (from the heat of the radiation) to, in my case, severe constipation, brought on by the six-week regimen combining an anti-nausea medication with concomitant temozolomide. Each of these can be addressed, but it's better to anticipate them in advance.

Hair loss can also start at random, and at different times for different patients. I'd ideally have shaved my head at the outset, rather than seeing big clumps of hair fall out — that can be quite mentally distressing.

It's a personalised neoantigen peptide vaccine made by CeGaT in Tübingen, Germany. They sequence your tumour tissue to design a vaccine specific to you, then manufacture it. It requires a tumour sample from surgery and a blood sample.

Standard radiation and chemotherapy can continue while it's being prepared. The published real-world results are in Latzer et al., Nature Communications (2024): nature.com/articles/s41467-024-51315-8

Roughly four to five months from start to first dose. Genetic sequencing of the tumour sample takes about a month; once you confirm you want to proceed, vaccine production takes a further few months.

There are 14 vaccinations in total, which work out to about 11 trips. On the first visit, four priming doses are given over 4–5 days; each subsequent visit administers one shot.

Visits start every 4–6 weeks and, with a positive immune response, the interval can stretch to two or three months. The full course runs over roughly 1.5 years.

Approximately 70,000–80,000 euros for the vaccine programme itself. Travel and accommodation are completely additional, so budget for those separately.

Unfortunately not. Because it's an experimental treatment it can't be shipped out and must be administered on site. The vaccine is produced in Tübingen, Germany.

A partner clinic in Vilnius, Lithuania offers the same approach and quality — sequencing and peptide synthesis are done in Germany, while administration happens in Vilnius.

You'll need a referral from your oncologist to the programme, then some paperwork. After they receive your tumour tissue and blood sample, they run the analysis and, once you confirm, begin manufacturing. Tumour tissue can be shipped via a courier such as DHL or FedEx.

I haven't experienced side effects myself, and age isn't considered a major factor for the vaccine.

This is broadly consistent with the published data: in the Latzer et al. study, adverse events were infrequent and predominantly mild (grade 1 or 2).

No special visa is needed — it's a standard Schengen visa, with the purpose of visit given as medical treatment. CeGaT provides a supporting letter and documentation to help make the case for a longer-term, multiple-entry visa, which is useful given the number of trips.

You can read about my experience in detail here.

Another centre some patients explore is IOZK in Cologne, Germany, which offers its own immunotherapy approach. I have no personal experience with it, but it's worth discussing with your oncologist as an option to research.

There are also premier institutes within India, such as Tata, that may be working on innovative new treatments. It's worth checking with your doctors about any options that might be available for you.

Optune is a wearable device. I was prescribed it through a doctor in London. To show a positive effect it needs to be worn for at least 18 hours a day.

It's worn more or less continuously, and the arrays need changing every 3–4 days, depending on how the individual's skin responds. Most caregivers manage this and get used to it after a few times; no nurse is needed.

More detail is on the official Optune Gio site: optunegio.com

It is very expensive — around £20,000 per month.

You can read about my experience in detail here.

I followed a personalised, nutritionist-guided diet throughout, alongside some natural supplements. I'd suggest working with a qualified nutritionist who can tailor a plan to the individual.

You can read about my experience in detail here.

I found it important to keep up regular exercise, including strength training to rebuild the muscle I lost during chemotherapy.

You can read about my experience in detail here.

Regular breathing exercises and keeping stress under control made a real difference. I had already been seeing a therapist for a couple of years before my diagnosis, so I only connected with them once in a while — but many patients and caregivers may benefit from having someone to share with.

You can read about my experience in detail here.