Skip to main content

Glioblastoma in the Elderly

  • Chapter
  • First Online:

Part of the book series: Cancer Treatment and Research ((CTAR,volume 163))

Abstract

There is no generally agreed upon standard of care treatment for elderly patients (age ≥70 years) with glioblastoma (GBM). Treatment options range from supportive care only, radiation therapy (RT) only (most often given in a shortened hypofractionated schedule), temozolomide (TMZ) chemotherapy only, and the combination RT + TMZ, followed by post-RT TMZ as is the current standard of care for younger good performance patients with newly diagnosed GBM.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Stupp R, Mason WP, Van Den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Eng J Med 352(10):987–996. doi:10.1056/NEJMoa043330

    Article  CAS  Google Scholar 

  2. Hess KR, Broglio KR, Bondy ML (2004) Adult glioma incidence trends in the United States, 1977–2000. Cancer 101(10):2293–2299. doi:10.1002/cncr.20621

    Article  PubMed  Google Scholar 

  3. Paszat L, Laperriere N, GroomeP Schulze K, Mackillop W, Holowaty E (2001) A population-based study of glioblastoma multiforme. Int J Rad Onc Biol Phys 51(1):100–107

    Article  CAS  Google Scholar 

  4. Dolecek TA, Propp JM, Stroup NE, Kruchko C (2012) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009. Neuro Oncol 14(Suppl 5):v1–49. doi:10.1093/neuonc/nos218

    Article  PubMed Central  PubMed  Google Scholar 

  5. Stupp R, Hegi Me, Mason WP et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10(5):459–466. doi:10.1016/S1470-2045(09)70025-70027

    Article  CAS  PubMed  Google Scholar 

  6. Keime-Guibert F, Chinot O, Taillandier L et al (2007) Radiotherapy for glioblastoma in the elderly. N Engl J Med 356(15):1527–1535. doi:10.1056/NEJMoa065901

    Article  CAS  PubMed  Google Scholar 

  7. Roa W, Brasher PM, Bauman G et al (2004) Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol 22(9):1583–1588. doi:10.1200/JCO.2004.06.082

    Article  CAS  PubMed  Google Scholar 

  8. Grossman SA, Ye X, Piantadosi S et al (2010) Survival of patients with newly diagnosed glioblastoma treated with radiation and temozolomide in research studies in the United States. Clin Cancer Res 16(8):2443–2449. doi:10.1158/1078-0432.CCR-09-3106

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Brem SS, Bierman PJ, Brem H et al (2011) Central nervous system cancers. J Natl Compr Canc Netw 9(4):352–400

    PubMed  Google Scholar 

  10. Iwamoto FM, Reiner AS, Panageas KS, Elkin EB, Abrey LE (2008) Patterns of care in elderly glioblastoma patients. Ann Neurol 64(6):628–634. doi:10.1002/ana.21521

    Article  PubMed  Google Scholar 

  11. Barnholtz-Sloan JS, Williams VL, Maldonado JL, Shahani D, Stockwell HG, Chamberlain M, Sloan AE (2008) Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma. J Neurosurg 108:642–648. doi:10.3171/JNS/2008/108/4/0642

    Article  PubMed  Google Scholar 

  12. Curran WJ Jr, Scott CB, Horton J, Nelson JS, Weinstein AS, Fischbach AJ, Chang CH, Rotman M, Asbell SO, Krisch RE (1993) Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 85(9):704–710

    Article  PubMed  Google Scholar 

  13. Hegi ME, Diserens AC, Gorlia T et al (2005) MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 352(10):997–1003. doi:10.1056/NEJMoa043331

    Article  CAS  PubMed  Google Scholar 

  14. Toedt G, Barbus S, Wolter M et al (2011) Molecular signatures classify astrocytic gliomas by IDH1 mutation status. Int J Cancer 128(5):1095–1103. doi:10.1002/ijc.25448

    Article  CAS  PubMed  Google Scholar 

  15. Parsons DW, Jones S, Zhang X, Lin JC, Leary RJ, Angenendt P, Mankoo P, Carter H, Siu IM, Gallia GL et al (2008) An integrated genomic analysis of human glioblastoma multiforme. Science 321(5897):1807–1812. doi:10.1126/science.1164382

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Yan H, Parsons DW, Jin G, McLendon R, Rasheed BA, Yuan W, Kos I, Batinic-Haberle I, Jones S, Riggins GJ et al (2009) IDH1 and IDH2 mutations in gliomas. N Engl J Med 360(8):765–773. doi:10.1056/NEJMoa0808710

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Hartmann C, Hentschel B, Wick W, Capper D, Felsberg J, Simon M, Westphal M, Schackert G, Meyermann R, Pietsch T et al (2010) Patients with IDH1 wild type anaplastic astrocytomas exhibit worse prognosis than IDH1-mutated glioblastomas, and IDH1 mutation status accounts for the unfavorable prognostic effect of higher age: implications for classification of gliomas. Acta Neuropathol 120(6):707–718. doi:10.1007/s00401-010-0781-z

    Article  PubMed  Google Scholar 

  18. Wick W, Platten M, Meisner C et al (2012) Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol 13(7):707–715. doi:10.1016/S1470-2045(12)70164-X

    Article  CAS  PubMed  Google Scholar 

  19. Gilbert M, Wang M, Aldape KD et al (2013) A randomized phase III trial comparing standard adjuvant temozolomide with a dose-dense schedule in newly diagnosed glioblastoma. J Clin Oncol 31(32):4085–4091. doi:10.1200/JCO.2013.49.6968

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Reifenberger G, Hentschel B, Felsberg J, Schackert G, Simon M, Schnell O, Westphal M, Wick W, Pietsch T, Loeffler M et al (2012) Predictive impact of MGMT promoter methylation in glioblastoma of the elderly. Int J Cancer 131(6):1342–1350. doi:10.1002/ijc.27385

    Article  CAS  PubMed  Google Scholar 

  21. Holdhoff M, Ye X, Blakeley JO, Blair L, Burger PC, Grossman SA, Diaz LA Jr (2012) Use of personalized molecular biomarkers in the clinical care of adults with glioblastomas. J Neurooncol 110(2):279–285. doi:10.1007/s11060-012-0968-3

    Article  CAS  PubMed  Google Scholar 

  22. Iwamoto FM, Cooper AR, Reiner AS, Nayak L, Abrey LE (2009) Glioblastoma in the elderly: the Memorial Sloan-Kettering Cancer Center Experience (1997–2007). Cancer 115(6):3758–3766. doi:10.1002/cncr.24413

    Article  PubMed  Google Scholar 

  23. Balducci L, Extermann M (2000) Management of cancer in the older person: a practical approach. Oncologist 5(3):224–237. doi:10.1634/theoncologist.5-3-224

    Article  CAS  PubMed  Google Scholar 

  24. Kita D, Ciernik IF, Vaccarella S, Franceschi S, Kleihues P, Lutolf UM, Ohgaki H (2009) Age as a predictive factor in glioblastomas: population-based study. Neuroepidemiology 33(1):17–22. doi:10.1159/000210017

    Article  PubMed  Google Scholar 

  25. Paszat L, Laperriere N, Groome P, Schulze K, Mackillop W, Holowaty E (2001) A population-based study of glioblastoma multiforme. Int J Radiat Oncol Biol Phys 51(1):100–107

    Article  CAS  PubMed  Google Scholar 

  26. Glantz M, Chamberlain MC, Liu Q, Litofsky NS, Recht LD (2003) Temozolomide as an alternative to irradiation for elderly patients with newly diagnosed malignant gliomas. Cancer 97(9):2262–2266. doi:10.1002/cncr.11323i

    Article  CAS  PubMed  Google Scholar 

  27. Chamberlain MC, Chalmers L (2007) A pilot study of primary temozolomide chemotherapy and deferred radiotherapy in elderly patients with glioblastoma. J Neurooncol 82(2):207–209

    Article  PubMed  Google Scholar 

  28. Brada M, Stenning S, Gabe R et al (2010) Temozolomide versus procarbazine, lomustine, and vincristine in recurrent high-grade glioma. J Clinical Oncol 28(30):4601–4608. doi:10.1200/JCO.2009.27.1932

    Article  CAS  Google Scholar 

  29. Malmstrom A, Gronberg BH, Marosi C, Stupp R, Frappaz D, Schultz H, Abacioglu U, Tavelin B, Lhermitte B, Hegi ME et al (2012) Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol 13(9):916–926. doi:10.1016/S1470-2045(12)70265-6

    Article  PubMed  Google Scholar 

  30. Gallego P-L, Ducray F, Chinot O et al (2011) Temozolomide in elderly patients with newly diagnosed glioblastoma and poor performance status: an ANOCEF phase II trial. J Clin Oncol 29(22):3050–3055. doi:10.1200/JCO.2011.34.8086

    Article  Google Scholar 

  31. Reyes-Botero G, Honnorat J, Chinot O et al. Temozolomide plus bevacizumab in elderly patients with newly diagnosed and poor performance status: An ANOCEF Phase 2 trial. J Clin Oncol 31, 2013 (suppl; abstr 2020)

    Google Scholar 

  32. Gilbert MR, Dignam JJ, Armstrong TS, Wefel JS et al (2014) A randomized trial of bevacizumab for newly diagnosed glioblastoma. N Engl J Med 370(8):699–708. doi:10.1056/NEJMoa1308573

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Chinot O, Wick W, Mason W et al (2014) Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. N Engl J Med 370(8):709–722. doi:10.1056/NEJMoa1308345

    Article  CAS  PubMed  Google Scholar 

  34. Sijben AE, McIntyre JB, Roldan GB, Easaw JC, Yan E, Forsyth PA, Parney IF, Magliocco AM, Bernsen H, Cairncross JG (2008) Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme. J Neurooncol 89(1):97–103. doi:10.1007/s11060-008-9593-6

    Article  PubMed  Google Scholar 

  35. Brandes AA, Franceschi E, Tosoni A, Benevento F, Scopece L, Mazzocchi V, Bacci A, Agati R, Calbucci F, Ermani M (2009) Temozolomide concomitant and adjuvant to radiotherapy in elderly patients with glioblastoma: correlation with MGMT promoter methylation status. Cancer 115(15):3512–3518. doi:10.1002/cncr.24406

    Article  CAS  PubMed  Google Scholar 

  36. Minniti G, Salvati M, Arcella A, Buttarelli F, D’Elia A, Lanzetta G, Esposito V, Scarpino S, Maurizi Enrici R, Giangaspero F (2011) Correlation between O6-methylguanine-DNA methyltransferase and survival in elderly patients with glioblastoma treated with radiotherapy plus concomitant and adjuvant temozolomide. J Neurooncol 102(2):311–316. doi:10.1007/s11060-010-0324-4

    Article  CAS  PubMed  Google Scholar 

  37. Minniti G, De Sanctis V, Muni R, Filippone F, Bozzao A, Valeriani M, Osti MF, De Paula U, Lanzetta G, Tombolini V et al (2008) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients. J Neurooncol 88(1):97–103. doi:10.1007/s11060-008-9538-0

    Article  CAS  PubMed  Google Scholar 

  38. Barker CA, Chang M, Chou JF, Zhang Z, Beal K, Gutin PH, Iwamoto FM (2012) Radiotherapy and concomitant temozolomide may improve survival of elderly patients with glioblastoma. J Neurooncol 109(2):391–397. doi:10.1007/s11060-012-0906-4

    Article  CAS  PubMed  Google Scholar 

  39. Combs SE, Wagner J, Bischof M, Welzel T, Edler L, Rausch R, Wagner F, Zabel-du Bois A, Debus J, Schulz-Ertner D (2008) Radiochemotherapy in patients with primary glioblastoma comparing two temozolomide dose regimens. Int J Radiat Oncol Biol Phys 71(4):999–1005. doi:10.1016/j.ijrobp.2007.11.064

    Article  CAS  PubMed  Google Scholar 

  40. Fiorica F, Berretta M, Colosimo C, Stefanelli A, Ursino S, Zanet E, Palmucci T, Maugeri D, Malaguarnera M, Palmucci S et al (2010) Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. Arch Gerontol Geriatr 51(1):31–35. doi:10.1016/j.archger.2009.06.011

    Article  CAS  PubMed  Google Scholar 

  41. Tanaka S, Meyer FB, Buckner JC, Uhm JH, Yan ES, Parney IF (2013) Presentation, management, and outcome of newly diagnosed glioblastoma in elderly patients. J Neurosurg 118(4):786–798. doi:10.3171/2012.10.JNS112268

    Article  PubMed  Google Scholar 

  42. Laperriere N, Weller M, Stupp R, Perry JR, Brandes AA, Wick W, van den Bent MJ (2013) Optimal management of elderly patients with glioblastoma. Cancer Treat Rev 39(4):350–357. doi:10.1016/j.ctrv.2012.05.008

    Article  PubMed  Google Scholar 

  43. Perry JR, Callaghan CO, Ding K et al (2012) A phase III randomized controlled trial of short-course radiotherapy with or without concomitant and adjuvant temozolomide in elderly patients with glioblastoma (NCIC CTG CE.6, EORTC 26062-22061, TROG 08.02). Can J Neuro Sci 39(1):16

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marc C. Chamberlain .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Chamberlain, M.C. (2015). Glioblastoma in the Elderly. In: Raizer, J., Parsa, A. (eds) Current Understanding and Treatment of Gliomas. Cancer Treatment and Research, vol 163. Springer, Cham. https://doi.org/10.1007/978-3-319-12048-5_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-12048-5_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-12047-8

  • Online ISBN: 978-3-319-12048-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics