Guidelines for the treatment of malignant gliomas in elderly patients

More than 80% of intracranial tumours in the elderly are malignant gliomas with aggressive behaviour. Older patients have been frequently excluded from clinical trials in view of their dismal prognosis and low tolerability of chemo-radiotherapy treatments, therefore they were underrepresented in the past oncological literature. Controversies in the use and dose of RT and in the administration of chemotherapeutic agents have not been solved by the small retrospective studies conducted so far. It appears reasonable that an aggressive treatment with surgery, full dose RT and, possibly, chemotherapy should be applied to patients with good performance status, preserved cognitive functions and no relevant comorbidities, although in the absence of randomised studies the balance of benefits and side effects of integrated treatments remains controversial. Patients with low performance status and/or serious comorbidities, unable to undergo surgery, may receive a shorter RT plan, or even no treatment at all, in consideration of the rapid course of their disease which may be shorter than the hypothetical benefit of any specific treatment. Further studies should be designed to perform a reliable analysis of prognostic factors of malignant gliomas in the elderly in order to tailor treatments to each patient to obtain the best feasible benefit without compromising their quality of life.