Recommendations for the management of malignant gliomas in the elderly

According to epidemiological estimations, the elderly are going to constitute an increasing proportion of patients with gliomas in the near future. Predominantly glioblastoma histology with invariably fatal outcome, disabling comorbidities and presumed low tolerability of radiochemotherapeutic treatments are the main reasons why elderly patients have been under-represented in the majority of neuro-oncological clinical trials conducted so far. Some small retrospective studies have reported that patients with good performance status receiving surgery plus radiotherapy, and sometimes chemotherapy, may achieve a survival comparable with that of younger patients, however, in the absence of randomized studies, the balance of benefits and adverse effects of aggressive treatments remains controversial. Multidisciplinary evaluation of prognostic factors, such as performance status, cognitive functions, tumor operability and burden of comorbidities, appears to be mandatory in order to choose which patients must not be deprived of an integrated treatment with surgery, full-dose radiotherapy and chemotherapy, and which patients may reasonably be given a shorter radiotherapy plan, or even no treatment at all due to the rapidly fatal course of their disease. Peculiar features of malignant gliomas in the elderly and some practical recommendations of management will be presented and discussed in this review.