Glioblastoma in the elderly: Current and future trends

Brandes, Alba A.; Compostella, A; Blatt, V.; Tosoni, Alicia

doi:10.1016/j.critrevonc.2006.06.014

Cited by 35 publications

(24 citation statements)

References 72 publications

(71 reference statements)

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“…Geriatric medicine often considers 65 years and older as elderly, although the definition varies. 4) We used an age limit of 70 years, because 65 years and younger are no longer considered as elderly. In our series, the oldest patient who underwent surgery was an 81-yearold woman.…”

Section: Discussionmentioning

confidence: 99%

“…10,13,[20][21][22][23][24][25][30][31][32][33]38) Age is considered a strong negative factor on survival. 10,[21][22][23][24][25]32,35,38) However, age should not be a reason for exclusion from aggressive treatment, 5,27,39,45) because the few investigations of the treatment of malignant gliomas in the elderly 4,10) have not defined the prognostic factors in this subgroup.…”

Section: Introductionmentioning

confidence: 99%

“…26) However, elderly patients with brain tumors should be treated based on sound scientific data and not ad hoc decisions. 4) Several prognostic factors have been identified in patients with malignant glioma, including age, performance status, histological grade, and extent of resection. 10,13,[20][21][22][23][24][25][30][31][32][33]38) Age is considered a strong negative factor on survival.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Factors in Elderly Patients With Supratentorial Malignant Gliomas

Kurimoto

Nagai

Kamiyama

et al. 2007

Neurol. Med. Chir.(Tokyo)

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The prognostic factors were retrospectively analyzed in 30 patients aged 70 years or over with supratentorial malignant gliomas treated by surgery in our hospital. The histological diagnosis was confirmed as grade 3 in 13 patients and grade 4 in 17. Seventeen patients received adjuvant radiation therapy. Only 10 patients underwent chemotherapy. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model. Univariate analysis showed preoperative Karnofsky performance status (KPS) score of 70 or greater and radiation therapy were significantly associated with longer survival. However, multivariate analysis revealed that preoperative KPS score of 70 or greater was the only independent prognostic factor and radiation therapy lost its significance due to selection bias. Neurological deterioration and medical complications occurred in six and seven patients, respectively. Performance status rather than histological grade is the key prognostic factor in elderly patients with supratentorial malignant gliomas. Patients with good preoperative KPS score should be aggressively treated with extensive resection and radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic Factors in Elderly Patients With Supratentorial Malignant Gliomas

Kurimoto

Nagai

Kamiyama

et al. 2007

Neurol. Med. Chir.(Tokyo)

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“…It is believed that stereotactic biopsy and the improvement and increased usage of imaging techniques have contributed to this upwards trend [3]. For those diagnosed, the current standard of care is surgical resection along with radiotherapy postoperatively [4]. The optimal management of this CNS neoplasm in the elderly is still a matter of debate, with several combinations beings studied.…”

Section: Introductionmentioning

confidence: 99%

“…The optimal management of this CNS neoplasm in the elderly is still a matter of debate, with several combinations beings studied. A number of small, prospective studies have shown the benefit of a tri-modal approach involving chemotherapy, radiation therapy, and surgical resection in elderly patients [4][5][6][7][8]. Most recently, RTOG studied the use of upfront stereotactic radiosurgery, radiation therapy, and carmustine (BCNU) versus radiation therapy and BCNU alone.…”

Section: Introductionmentioning

confidence: 99%

Radiosurgery with chemotherapy as an alternative to RT for glioblastoma multiforme patients 65 years old or older: a prospective review of 40 patients

Bortoletto¹,

Wolf²,

Wolf³

et al. 2011

Cureus

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Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma

Brandes

Franceschi

Tosoni

et al. 2009

Cancer

Self Cite

200

107

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BACKGROUND: A recent randomized study conducted on newly diagnosed glioblastoma (GBM) patients demonstrated that concomitant and adjuvant temozolomide added to standard radiotherapy had a survival advantage compared with radiotherapy alone. The overall survival benefit of this aggressive treatment, however, was attenuated in older or poor performance status patients. The aim of the present study was to verify the activity and the toxicity of temozolomide administration concurrent and adjuvant to radiotherapy as first‐line treatment for elderly GBM patients, and to explore correlations between clinical outcome and O6 methylguanine‐DNA methyltransferase (MGMT) promoter methylation status. METHODS: Newly diagnosed GBM patients ≥65 years were considered eligible. Treatment comprised radiotherapy (60 Gy in 30 fractions over 6 weeks) plus continuous daily temozolomide (75 mg/m2/day), followed by 12 maintenance temozolomide cycles (150 mg/m2 once a day for 5 consecutive days every 28 days) if MRI showed no enhancement suggesting a tumor; otherwise, chemotherapy was delivered until complete response or unequivocal progression. RESULTS: A total of 58 patients (34 males; median age, 68 years; range, 65‐82 years) were enrolled. Sixteen patients (43%) presented MGMT promoter methylated and 21 unmethylated (57%) status. The median progression‐free survival and median survival time (MST) were 9.5 months (95% confidence interval [CI], 8.6‐10.5) and 13.7 months (95% CI, 10‐17.3 months), respectively. Mental status deterioration grade 3‐4 was detected in 25% of patients. Leukoencephalopathy was diagnosed in 10% of patients. CONCLUSIONS: The overall and progression‐free survival of patients given concomitant and adjuvant temozolomide are greater than in those given radiotherapy alone; however, this regimen incurs a greater deterioration in mental status. Further randomized trials should, therefore, be conducted to investigate the efficacy and against the toxicity of this regimen as first‐line therapy in patients with GBM. Cancer 2009. © 2009 American Cancer Society.

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Glioblastoma in the elderly: Current and future trends

Cited by 35 publications

References 72 publications

Prognostic Factors in Elderly Patients With Supratentorial Malignant Gliomas

Prognostic Factors in Elderly Patients With Supratentorial Malignant Gliomas

Radiosurgery with chemotherapy as an alternative to RT for glioblastoma multiforme patients 65 years old or older: a prospective review of 40 patients

Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma

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