Background: Primary malignant brain tumors (PBT) impose substantial burdens on patients and caregivers. Caregivers are essential in the delivery of outpatient care for patients with PBT but experience high levels of fatigue, distress, and health decline. Although exercise is known to improve outcomes in cancer patients, interventions tailored specifically to the PBT patient–caregiver dyad remain limited. Dyadic intervention, as well as exercise oncology, are emerging areas of active research in neuro-oncology. This scoping review incorporates both principles to evaluate the existing literature on exercise interventions on primary brain tumor patient–caregiver dyads. Methods: We conducted a comprehensive search of MEDLINE (PubMed), Embase, CINAHL (EBSCO), Rehabilitation & Sports Medicine (EBSCO), and Cochrane Central (Ovid) in December 2025 for studies involving exercise interventions that included adult PBT patients and caregivers. Results: Of the 1126 records screened, eight studies were included: four yoga-based interventions (three feasibility trials and one ongoing multicenter RCT), one pilot ski-based intervention, and three aerobic and resistance training-based interventions (two qualitative and one ongoing trial). The interventions were safe and feasible, with high adherence and retention. The preliminary reported benefits included improvements in fatigue, sleep, quality of life, and caregiver distress for the dyads. Videoconference delivery was effective, particularly during the COVID-19 pandemic. The eight included studies comprised 5–67 dyads, with four being single-arm feasibility studies. Conclusions: Current literature on dyadic exercise intervention in neuro-oncology consists primarily of small-scale feasibility and pilot studies. Initial findings have demonstrated that such interventions are safe. However, preliminary efficacy remains limited due to the risk of bias and lack of statistical power. Larger randomized clinical trials with objective endpoints are needed to define efficacy and guide evidence-based protocols.

We report a 19-year-old female with a non-enhancing, diffuse pediatric-type high-grade glioma, H3-wildtype and IDH-wildtype, harboring a germline ATM alteration. She presented with headaches, diplopia, papilledema, and obstructive hydrocephalus, and had a Karnofsky Performance Status of 70. MRI revealed infiltrative signal abnormality, and amino acid [F18]Fluciclovine PET/MRI identified increased avidity in the right lateral thalamus which guided biopsy sampling. Histopathology showed a hypercellular infiltrative glioma with high mitotic activity. DNA sequencing analysis with matched germline whole-exome sequencing identified a pathogenic ATM mutation, with biallelic ATM deficiency in tumor. Genome-wide DNA methylation confirmed the diagnosis. The patient received craniospinal radiation with a boost and concurrent temozolomide. She achieved rapid and significant neurologic recovery of function with KPS increasing to 90, accompanied by radiographic improvement. This case highlights the utility of PET/MRI in biopsy planning and underscores the importance of integrated histological and molecular diagnosis for management of non-enhancing gliomas.

Glioblastoma (GBM) is devastating both in prognosis and in patient impact. Differing from other solid tumors, GBM produces significant, often rapid, neurologic decline necessitating intense caregiving. This care usually falls to an intimate partner or family member. Early studies in GBM patient–caregiver dyads confirm substantial caregiver needs. Most caregivers report significant distress, with nearly 40% reporting depression and anxiety. Educational initiatives, early palliative care, and psychotherapy have increased caregiver preparedness. However, current healthcare delivery is organized primarily around the patient, and few systems offer caregiver-specific interventions. Early evidence suggests that focused efforts to improve caregiver quality of life may improve patient survival and healthcare utilization, incentivizing the healthcare team to further investigate how to best support the patient–caregiver dyad. The literature in other tumor types suggests dyad-based interventions may also reduce distress more effectively than caregiver or patient-based interventions alone. Further research is needed to design an optimal supportive-care model for GBM dyads. Across each stage of the disease course (from diagnosis and treatment to surveillance, progression, and bereavement), the needs of the dyad are dynamic. This requires targeted and adaptive interventions such as nurse-led navigation, structured education, anticipatory guidance, and clinical supportive-care programs or clinical trials aimed at improving dyadic physical and psychological well-being at different time points during the disease course. Ultimately, future studies evaluating caregiver support in GBM are needed and should assess not only psychological benefits and patient survival, but also programmatic implementation, clinical trial participation, and healthcare utilization efficiency.