Skip to main content
Top
Published in: Current Oncology Reports 12/2017

01-12-2017 | Geriatric Oncology (AR MacKenzie, Section Editor)

Treatment of Glioblastoma in Older Adults

Authors: Kelly Braun, Manmeet S. Ahluwalia

Published in: Current Oncology Reports | Issue 12/2017

Login to get access

Abstract

Glioblastoma is the most common primary malignant brain tumor diagnosed in the USA and is associated with a poor prognosis. The outcomes in elderly patients (more than 65 years of age) are worse when compared to those younger than age 65 at the time of diagnosis. Older patients are not always offered treatments that would otherwise be considered standard of care due to comorbidities and concerns about toxicity and tolerability. The initial European Organization for Research and Treatment of Cancer study that led to approval of temozolomide in glioblastoma excluded patients more than 70 years of age. This review outlines challenges that arise in the treatment of glioblastoma in the elderly population and discusses results of recent studies that established the role of adjuvant chemotherapy in addition to radiation and surgery. There is evidence that these patients can benefit from a more aggressive and safe resection, from hypofractionated radiation treatments, and from adjuvant temozolomide.
Literature
20.
go back to reference • Marko NF, Weil RJ, Schroeder JL, Lang FF, Suki D, Sawaya RE. Extent of resection of glioblastoma revisited: personalized survival modeling facilitates more accurate survival prediction and supports a maximum-safe-resection approach to surgery. J Clin Oncol. 2014;32(8):774–82. https://doi.org/10.1200/JCO.2013.51.8886. This analysis produced survival models for patients with glioblastoma of various ages and demonstrated relationships between survival and extent of resection, highlighting the importance of surgical resection in the treatment of these tumors. CrossRefPubMedPubMedCentral • Marko NF, Weil RJ, Schroeder JL, Lang FF, Suki D, Sawaya RE. Extent of resection of glioblastoma revisited: personalized survival modeling facilitates more accurate survival prediction and supports a maximum-safe-resection approach to surgery. J Clin Oncol. 2014;32(8):774–82. https://​doi.​org/​10.​1200/​JCO.​2013.​51.​8886. This analysis produced survival models for patients with glioblastoma of various ages and demonstrated relationships between survival and extent of resection, highlighting the importance of surgical resection in the treatment of these tumors. CrossRefPubMedPubMedCentral
21.
go back to reference • Noorbakhsh A, Tang JA, Marcus LP, et al. Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis. J Neurosurg. 2014;120(1):31–9. https://doi.org/10.3171/2013.9.JNS13877. This paper demonstrated that elderly patients with glioblastoma are less likely to receive a gross total resection in comparison with younger patients. CrossRefPubMed • Noorbakhsh A, Tang JA, Marcus LP, et al. Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis. J Neurosurg. 2014;120(1):31–9. https://​doi.​org/​10.​3171/​2013.​9.​JNS13877. This paper demonstrated that elderly patients with glioblastoma are less likely to receive a gross total resection in comparison with younger patients. CrossRefPubMed
25.
go back to reference • Arvold ND, Tanguturi SK, Aizer AA, et al. Hypofractionated versus standard radiation therapy with or without temozolomide for older glioblastoma patients. Int J Radiat Oncol. 2015;92(2):384–9. https://doi.org/10.1016/j.ijrobp.2015.01.017. This study demonstrated that when controlling for the selection bias against patients with a lower performance status, there were no overall survival differences between SRT and HRT when given with concurrent TMZ in elderly patients. CrossRef • Arvold ND, Tanguturi SK, Aizer AA, et al. Hypofractionated versus standard radiation therapy with or without temozolomide for older glioblastoma patients. Int J Radiat Oncol. 2015;92(2):384–9. https://​doi.​org/​10.​1016/​j.​ijrobp.​2015.​01.​017. This study demonstrated that when controlling for the selection bias against patients with a lower performance status, there were no overall survival differences between SRT and HRT when given with concurrent TMZ in elderly patients. CrossRef
35.
go back to reference •• Perry JR, Laperriere N, O’Callaghan CJ, et al. Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med. 2017;376(11):1027–37. https://doi.org/10.1056/NEJMoa1611977. This study demonstrated that the addition of temozolomide to short-course radiotherapy prolongs survival in elderly patients with glioblastoma without sacrifice in quality of life. CrossRefPubMed •• Perry JR, Laperriere N, O’Callaghan CJ, et al. Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med. 2017;376(11):1027–37. https://​doi.​org/​10.​1056/​NEJMoa1611977. This study demonstrated that the addition of temozolomide to short-course radiotherapy prolongs survival in elderly patients with glioblastoma without sacrifice in quality of life. CrossRefPubMed
43.
go back to reference • Mason M, Laperriere N, Wick W, et al. Glioblastoma in the elderly: making sense of the evidence. Neuro-Oncology Pract. 2016;3(2):77–86. https://doi.org/10.1093/nop/npv027. This is a systematic review of evidence regarding glioblastoma care in the elderly that discusses the role of bevacizumab. CrossRef • Mason M, Laperriere N, Wick W, et al. Glioblastoma in the elderly: making sense of the evidence. Neuro-Oncology Pract. 2016;3(2):77–86. https://​doi.​org/​10.​1093/​nop/​npv027. This is a systematic review of evidence regarding glioblastoma care in the elderly that discusses the role of bevacizumab. CrossRef
Metadata
Title
Treatment of Glioblastoma in Older Adults
Authors
Kelly Braun
Manmeet S. Ahluwalia
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Oncology Reports / Issue 12/2017
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-017-0644-z

Other articles of this Issue 12/2017

Current Oncology Reports 12/2017 Go to the issue

Gynecologic Cancers (NS Reed, Section Editor)

What’s New in Imaging for Gynecologic Cancer?

Integrative Care (C Lammersfeld, Section Editor)

B Vitamin Complex and Chemotherapy-Induced Peripheral Neuropathy

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine