Radiation therapy for older patients with brain tumors

Abstract

The incidence of brain tumors in the elderly population has increased over the last few decades. Current treatment includes surgery, radiotherapy and chemotherapy, but the optimal management of older patients with brain tumors remains a matter of debate, since aggressive radiation treatments in this population may be associated with high risks of neurological toxicity and deterioration of quality of life. For such patients, a careful clinical status assessment is mandatory both for clinical decision making and for designing randomized trials to adequately evaluate the optimal combination of radiotherapy and chemotherapy.Several randomized studies have demonstrated the efficacy and safety of chemotherapy for patients with glioblastoma or lymphoma; however, the use of radiotherapy given in association with chemotherapy or as salvage therapy remains an effective treatment option associated with survival benefit. Stereotactic techniques are increasingly used for the treatment of patients with brain metastases and benign tumors, including pituitary adenomas, meningiomas and acoustic neuromas. Although no randomized trials have proven the superiority of SRS over other radiation techniques in older patients with brain metastases or benign brain tumors, data extracted from recent randomized studies and large retrospective series suggest that SRS is an effective approach in such patients associated with survival advantages and toxicity profile similar to those observed in young adults. Future trials need to investigate the optimal radiation techniques and dose/fractionation schedules in older patients with brain tumors with regard to clinical outcomes, neurocognitive function, and quality of life.

Assessment of treatment approach and survival outcomes in a modern cohort of patients with primary gliosarcoma using the national cancer database

“…In addition to the less favorable tumor biology and comorbidities associated with advanced age, it is possible that the shorter OS in older patients can be partly attributed to their lesser likelihood of receiving trimodality therapy, which has been shown in our study to improve OS regardless of age. The concern about adjuvant RT in elderly glioblastoma patients is neurotoxicity, which would outweigh any survival benefit conferred by RT [38][39][40]. The link between comorbidity and receipt of treatment remains unclear, even in glioblastoma patients.…”

Sensory changes and lipoprotein ratios in patients with brain cancers during cancer‐related therapy: A prospective cross‐sectional study

“…This prospective study was conducted from January 2015 to December 2017 in a hospital with more than 1,500 beds; data collection was performed prior to the initiation of CRT, 2-3 weeks after the initiation of CRT, and 4-6 weeks after the initiation of CRT. In our study, CRT was performed three times in accordance with the previous study (Davis, 2016;Minniti et al, 2017), which described the most frequently observed symptoms in patients with CRT. Convenience sampling was conducted in a hospital or outpatient clinic.…”

Dose Gradient Index for Stereotactic Radiosurgery/Radiation Therapy

“…RTOG criteria for CI determine the quality of conformity. 2,24 Due to the emphasis of this study to recommend the DGI guidelines for intracranial SRS/SRT treatments, only plans that were ideal per RTOG 0915 1 and 0813 2 (1 CI < 1.2) were considered.…”

“…It has been demonstrated to increase patient survival rates and improve quality of life. 1,2 The conventional treatment technique for both identifiable brain metastasis and prophylaxis for microscopic disease is stereotactic radiosurgery (SRS)/stereotactic radiation therapy (SRT) with or without whole brain radiation therapy. 3 SRS provides accurate delivery of a high dose of radiation to a target in a single fraction while sparing the surrounding normal tissue.…”