Optimal management of elderly patients with glioblastoma

Laperrière, Normand; Weller, Michael; Stupp, Roger; Perry, James; Brandes, Alba A.; Wick, Wolfgang; Bent, Martin J. van den

doi:10.1016/j.ctrv.2012.05.008

Cited by 136 publications

(90 citation statements)

References 58 publications

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“…. 17 This may reflect less robust effects of the combined approach in the elderly or may be due to lower statistical power in the subgroup analysis. 19 The study sample of 2836 patients identified from the Surveillance, Epidemiology, and End Results (SEER) registry database had a median age of 76·9 years (range 71·0-98·0).…”

Section: Surgerymentioning

confidence: 99%

Glioblastoma in the elderly: making sense of the evidence

Mason

Laperrière

Wick

et al. 2015

Neuro-Oncology Practice

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Section: Surgerymentioning

confidence: 99%

Glioblastoma in the elderly: making sense of the evidence

Mason

Laperrière

Wick

et al. 2015

Neuro-Oncology Practice

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“…Hence, older patients already account for nearly half of all patients suffering from GBM [4]. In this sense, the continuous aging of the population will lead to a significant increase (at least twofold) in the number of cases of GBM in elderly patients in the following two decades [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Management of Elderly Patients With Gliomas

Pérez-Larraya

Delattre

2014

The Oncologist

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The current progressive aging of the population is resulting in a continuous increase in the incidence of gliomas in elderly people, especially the most frequent subtype, glioblastoma (GBM). This sociohealth shift, known as the "silver tsunami," has prompted the neuro-oncology community to investigate the role of specific antitumor treatments, such as surgery, radiotherapy, chemotherapy, and other targeted therapies, for these traditionally undertreated patients. Advanced age, a widely recognized poor prognostic factor in both low-grade glioma (LGG) and high-grade glioma patients, should no longer be the sole reason for excluding such older patients from receiving etiologic treatments. Far from it, results from recent prospective trials conducted on elderly patients with GBM demonstrate that active management of these patients can have a positive impact on survival without impairing either cognition or quality of life. Although prospective studies specifically addressing the management of grade 2 and 3 gliomas are lacking and thus needed, the aforementioned tendency toward acknowledging a therapeutic benefit for GBM patients might also apply to the treatment of patients with LGG and anaplastic gliomas. Inorder tooptimize such etiologic treatment in conjunction with symptomatic management, neuro-oncology multidisciplinary boards must individually consider important features such as resectability of the tumor, functional and cognitive status, associated comorbidities, and social support.

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“…However, an analysis by age strata showed a diminishing benefit of TMZ association with increasing age, especially in patients older than 65 years (221). Caution should be made in interpreting these results as the group over the age of 65 years represented only 15% of the study population.…”

Section: Chemotherapy and Radiotherapymentioning

confidence: 87%

Current Standards of Care in Glioblastoma Therapy

et al. 2017

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Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Regardless of ideal multidisciplinary treatment, including maximal surgical resection, followed by radiotherapy plus concomitant and maintenance temozolomide (TMZ), almost all patients experience tumor progression with nearly universal mortality and a median survival of less than 15 months. The addition of bevacizumab to standard treatment with TMZ revealed no increase in overall survival (OS) but improved progression-free survival (PFS). In newly diagnosed GBM, methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter has been shown to predict response to alkylating agents, as well asgnosis. Therefore, MGMT promoter status may have a crucial role in the choice of single modality treatment in fragile elderly population. No standard of care is established in recurrent or progressive GBM. Treatment alternatives may include supportive care, surgery, re-irradiation, systemic therapies, and combined modality therapy. Despite numerous clinical trials, the identification of effective therapies is complex because of the lack of appropriate control arms, selection bias, small sample sizes, and disease heterogeneity. Tumor-treating fields plus TMZ represent a major advance in the field of GBM therapy, and should be Standards of Care in Glioblastoma Therapy 198 considered for patients with newly diagnosed GBM with no contraindications. As a disease with such a poor prognosis, treatment of GBM should go beyond improving survival and aim at preserving and even improving the quality of life of both the patient and the caregiver.

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Optimal management of elderly patients with glioblastoma

Cited by 136 publications

References 58 publications

Glioblastoma in the elderly: making sense of the evidence

Glioblastoma in the elderly: making sense of the evidence

Management of Elderly Patients With Gliomas

Current Standards of Care in Glioblastoma Therapy

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