Treatment of High-Grade Gliomas in the Elderly

Abstract

In recent years the elderly population has grown, and in this category there has been a marked increase in the incidence of cancers with a poor prognosis, brain tumors in particular. However, few authors have focused on treatment for high-grade gliomas in the elderly, which often present problems different from those in younger populations. Several authors have observed that this tumor has a poor response to surgery, radiotherapy and chemotherapy. Elderly patients are therefore frequently undertreated or excluded from cancer therapy trials. Their exclusion from conventional cancer treatment often depends on ad hoc decisions and assumptions by physicians rather than on sound scientific data.

Risk factors for postoperative systemic complications in elderly patients with brain tumors

“…3 Therefore, to decrease the risk of postoperative systemic complications in elderly patients with brain tumors, it is important to assess the risk of such complications preoperatively and prepare for surgery based on the medical evidence.…”

Can Elderly Patients With Newly Diagnosed Glioblastoma be Enrolled in Radiochemotherapy Trials?

“…14 No randomized trial was conducted to determine which regime was preferred (standard vs. less intensive vs. palliative approach) even if most authors concluded that elderly with good Karnofsky Performance Status (KPS) should be treated with standard chemoradiation. 3,[15][16][17] However, a cutoff age could not be the single factor useful to define who are the frail elderly for the palliative approach or best supportive care. 13,18 Recently, in fact, much more importance has been given to comorbidity and its prognostic role in GBM.…”

Glioblastoma in the elderly: Current and future trends

“…Investigations on the treatment of high-grade gliomas in the elderly are scarce [4] and patients in this age category are often excluded from clinical trials focusing on novel treatments [5], thus being deprived of state-of-the-art investigational treatments. It has not yet been reliably established whether or not the incidence of primary brain tumors is increasing in the elderly population, although this issue has been widely debated in recent decades.…”

“…Improvements in treatments for the more common illnesses and the consequently longer life expectancy may have prolonged the time for brain, breast and colon cancers to develop and become symptomatic [5]. Clinicians and pathologists will thus encounter an increasingly large number of elderly GBM patients, although the statistics reported may vary, depending on referral patterns and social issues influencing the access that elderly patients have to medical care.…”

“…surgical resection, radiotherapy and chemotherapy) in this subgroup of patients with a confirmed diagnosis of GBM. Advocates of "aggressive therapy" using one or more of the post-biopsy treatment modalities argue that an older patient should not be denied standard care, which may prolong survival [5], while others maintain that "aggressive, heroic treatment" does not necessarily achieve a significantly improved outcome, only worsening quality of life [24].…”