The following is a summary of “Management of glioblastoma in elderly patients: A review of the literature,” published in the March 2024 issue of Oncology by Mazarakis et al.
High-grade gliomas represent the most prevalent aggressive primary brain tumors, characterized by an unfavorable prognosis with a median survival of less than 2 years. The standard management protocol for newly diagnosed glioblastoma patients typically involves surgical intervention followed by a combination of radiotherapy and chemotherapy, typically utilizing temozolomide, with further adjuvant temozolomide administration. Recent strides in molecular profiling of high-grade gliomas have significantly enriched the understanding of the disease pathology. However, despite the standardization of glioblastoma management in newly diagnosed adult patients, considerable debate persists regarding the optimal treatment approach for newly diagnosed elderly glioblastoma patients.
In this comprehensive review, researchers endeavor to synthesize existing literature findings about surgical interventions, radiotherapy, chemotherapy, and their integrated approaches, aiming to delineate the most effective management strategies tailored to this patient demographic. Elderly patients aged 65–70, exhibiting an excellent functional status, may be deemed suitable candidates for standard treatment protocols involving surgery, concomitant and adjuvant temozolomide alongside standard radiotherapy. Similarly, elderly patients above 70, demonstrating a favorable functional status, may undergo similar treatment regimens except potentially receiving abbreviated courses of radiotherapy. Conversely, elderly glioblastoma patients presenting with compromised functional status and MGMT promoter methylation may benefit from temozolomide chemotherapy. In contrast, those unable to tolerate chemotherapy may explore hypofractionated radiotherapy as a viable alternative.
In contrast to their younger counterparts, it becomes evident that a meticulous and individualized approach is paramount in guiding treatment decisions for elderly glioblastoma patients, considering their unique clinical characteristics and treatment tolerances.
Source: sciencedirect.com/science/article/pii/S2405630824000387