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Glioblastoma in the elderly: initial management.

Fabio Ynoe de Moraes¹, Normand Laperriere²

¹Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, ON, Canada.

Chinese Clinical Oncology

|August 27, 2017

Summary

For elderly glioblastoma patients, hypofractionated radiotherapy with temozolomide offers improved outcomes. This combined modality treatment is recommended for eligible patients, showing better survival rates in recent trials.

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Area of Science:

Neuro-oncology
Geriatric Oncology
Radiation Oncology

Background:

Glioblastoma is the most common primary brain tumor, particularly in the elderly.
It presents a significant challenge due to its poor prognosis.
Surgical resection is crucial for diagnosis, molecular analysis, and maximal tumor removal.

Purpose of the Study:

To evaluate the efficacy of different post-operative treatment strategies for elderly glioblastoma patients.
To determine the optimal treatment approach based on MGMT promoter methylation status and patient performance.
To assess the role of hypofractionated radiotherapy with temozolomide in this population.

Main Methods:

Analysis of treatment outcomes from the CCTG CE.6/EORTC 26062-22061 phase III trial.

Keywords:

Glioblastoma elderly outcomes

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Randomization of newly diagnosed glioblastoma patients (≥65 years) to hypofractionated radiotherapy (HRT) with concurrent and adjuvant temozolomide (TMZ) versus HRT alone.

Consideration of MGMT promoter methylation status for treatment selection.

Main Results:

The trial demonstrated positive survival outcomes for elderly glioblastoma patients receiving HRT with concurrent and adjuvant TMZ.
Combined modality therapy (CMT) with HRT and TMZ showed improved results compared to HRT alone.
MGMT promoter methylation status is a key factor in treatment decision-making.

Conclusions:

Combined modality therapy (CMT) using hypofractionated radiotherapy with concurrent temozolomide should be considered as the initial post-surgical approach for eligible elderly glioblastoma patients.
MGMT methylation status guides treatment choices, including TMZ alone for frail patients.
Further research is needed to develop novel approaches for this aggressive malignancy.