Skip to main content

Advertisement

SpringerLink
Log in

Treatment of Glioblastoma in “Elderly” Patients

  • CNS Malignancies
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The number of patients over 65 with newly diagnosed glioblastoma is anticipated to increase significantly in coming decades as a result of demographic shifts in the United States. Older patients with this disease have a significantly worse life expectancy compared with patients under 65. Mounting clinical evidence suggests that fit elderly patients with glioblastoma benefit from the addition of temozolomide to standard surgery and radiation. As a result, for healthy patients over 65 we recommend maximal surgical debulking followed by involved-field radiotherapy (60 Gy in 30 fractions) with concurrent temozolomide (75 mg/m2/day) and 6 months of adjuvant temozolomide (150–200 mg/m2/day for five consecutive days/month). Patients over 65 with newly diagnosed or recurrent glioblastoma should also be considered for inclusion in clinical trials. MGMT is a validated prognostic marker in patients over 65 and may be useful in clinical decision-making in frail elderly patients. Age alone should not be a factor in deciding how patients with newly diagnosed glioblastoma should be treated.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References Recommended and Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Yabroff KR, Lamont EB, Mariotto A, et al. Cost of care for elderly cancer patients in the United States. J Natl Cancer Inst. 2008;100(9):630–41.

    Article  PubMed  Google Scholar 

  2. Centers for Disease Control. Public health and aging: trends in aging, United States and worldwide. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5206a2.htm. Accessed November 2010.

  3. Ohgaki H, Dessen P, Jourde B, et al. Genetic pathways to glioblastoma: a population-based study. Cancer Res. 2004;64(19):6892–9.

    Article  PubMed  CAS  Google Scholar 

  4. Wrensch M, Minn Y, Chew T, et al. Epidemiology of primary brain tumors: current concepts and review of the literature. Neuro Oncol. 2002;4(4):278–99.

    PubMed  Google Scholar 

  5. Curran Jr WJ, Scott CB, Horton J, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst. 1993;85(9):704–10.

    Article  PubMed  Google Scholar 

  6. Li J, Wang M, Won M, et al. Validation and simplification of the Radiation Therapy Oncology Group Recursive Partitioning Analysis Classification for Glioblastoma. Int J Radiat Oncol Biol Phys. 2010; Sep 30.

  7. Buckner JC. Factors influencing survival in high grade gliomas. Semin Oncol. 2003;30(6 Suppl 19):10–4.

    Article  PubMed  Google Scholar 

  8. Scott JN, Rewcastle NB, Brasher PM, et al. Long-term glioblastoma multiforme survivors: a population-based study. Can J Neurol Sci. 1998;25(3):197–201.

    PubMed  CAS  Google Scholar 

  9. Grossman SA, Ye X, Piantadosi S, et al. Survival of patients with newly diagnosed glioblastoma treated with radiation and temozolomide in research studies in the United States. Clin Cancer Res. 2010; 15;16(8):2443–9.

    Article  PubMed  CAS  Google Scholar 

  10. Westphal M, Ram Z, Riddle V, et al. Gliadel wafer in initial surgery for malignant glioma: long-term follow-up of a multicenter controlled trial. Acta Neurochir Wien. 2006;148(3):269–75.

    Article  PubMed  CAS  Google Scholar 

  11. Attenello FJ, Mukherjee D, Datoo G, et al. Use of Gliadel (BCNU) wafer in the surgical treatment of malignant glioma: a 10-year institutional experience. Ann Surg Oncol. 2008;15(10):2887–93.

    Article  PubMed  Google Scholar 

  12. Kelly PJ, Daumas-Duport C, Kispert DB, et al. Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg. 1987;66(6):865–74.

    Article  PubMed  CAS  Google Scholar 

  13. Halperin EC, Bentel G, Heinz ER, et al. Radiation therapy treatment planning in supratentorial glioblastoma multiforme: an analysis based on post mortem topographic anatomy with CT correlations. Int J Radiat Oncol Biol Phys. 1989;17(6):1347–50.

    Article  PubMed  CAS  Google Scholar 

  14. Simpson JR, Horton J, Scott C, et al. Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys. 1993;26(2):239–44.

    Article  PubMed  CAS  Google Scholar 

  15. Walker MD, Strike TA, Sheline GE. An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys. 1979;5(10):1725–31.

    PubMed  CAS  Google Scholar 

  16. Souhami L, Seiferheld W, Brachman D, et al. Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93–05 protocol. Int J Radiat Oncol Biol Phys. 2004;60(3):853–60.

    Article  PubMed  Google Scholar 

  17. Welsh J, Sanan A, Gabayan AJ, et al. GliaSite brachytherapy boost as part of initial treatment of glioblastoma multiforme: a retrospective multi-institutional pilot study. Int J Radiat Oncol Biol Phys. 2007;68(1):159–65.

    Article  PubMed  Google Scholar 

  18. Coughlin C, Scott C, Langer C, et al. Phase II, two-arm RTOG trial (94–11) of bischloroethyl-nitrosourea plus accelerated hyperfractionated radiotherapy (64.0 or 70.4 Gy) based on tumor volume (> 20 or < or = 20 cm(2), respectively) in the treatment of newly-diagnosed radiosurgery-ineligible glioblastoma multiforme patients. Int J Radiat Oncol Biol Phys. 2000;48(5):1351–8.

    Article  PubMed  CAS  Google Scholar 

  19. Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10(5):459–66.

    Article  PubMed  CAS  Google Scholar 

  20. Walker MD, Alexander Jr E, Hunt WE, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg. 1978;49(3):333–43.

    Article  PubMed  CAS  Google Scholar 

  21. Gorlia T, van den Bent MJ, Hegi ME, et al. Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. Lancet Oncol. 2008;9(1):29–38.

    Article  PubMed  Google Scholar 

  22. Weller M, Felsberg J, Hartmann C, et al. Molecular predictors of progression-free and overall survival in patients with newly diagnosed glioblastoma: a prospective translational study of the German Glioma Network. J Clin Oncol. 2009;27(34):5743–50.

    Article  PubMed  CAS  Google Scholar 

  23. Minniti G, Salvati M, Arcella A, et al. Correlation between O(6)-methylguanine-DNA methyltransferase and survival in elderly patients with glioblastoma treated with radiotherapy plus concomitant and adjuvant temozolomide. J Neurooncol. 2010; Aug 5. An analysis of 83 patients older than 70 suggesting that MGMT status may outweigh age as a prognostic factor in the elderly population.

  24. Batchelor TT, Betensky RA, Esposito JM, et al. Age-dependent prognostic effects of genetic alterations in glioblastoma. Clin Cancer Res. 2004;10(1 Pt 1):228–33.

    Article  PubMed  CAS  Google Scholar 

  25. Iwamoto FM, Reiner AS, Panageas KS, et al. Patterns of care in elderly glioblastoma patients. Ann Neurol. 2008;64(6):628–34.

    Article  PubMed  Google Scholar 

  26. Scott J, Tsai YY, Chinnaiyan P, et al. Effectiveness of Radiotherapy for Elderly Patients with Glioblastoma. Int J Radiat Oncol Biol Phys. 2010; Jul 31 (e-pub ahead of print).

  27. Iwamoto FM, Cooper AR, Reiner AS, et al. Glioblastoma in the elderly: the Memorial Sloan-Kettering Cancer Center Experience (1997–2007). Cancer. 2009;115(16):3758–66.

    Article  PubMed  Google Scholar 

  28. Kelly PJ, Hunt C. The limited value of cytoreductive surgery in elderly patients with malignant gliomas. Neurosurgery. 1994;34(1):62–6. discussion 66–7.

    Article  PubMed  CAS  Google Scholar 

  29. Chaichana KL, Garzon-Muvdi T, Parker S, et al. Supratentorial Glioblastoma Multiforme: The Role of Surgical Resection Versus Biopsy Among Older Patients. Ann Surg Oncol. 2010; Aug 10. [Epub ahead of print].

  30. Vuorinen V, Hinkka S, Färkkilä M, et al. Debulking or biopsy of malignant glioma in elderly people - a randomised study. Acta Neurochir Wien. 2003;145(1):5–10.

    Article  PubMed  CAS  Google Scholar 

  31. Keime-Guibert F, Chinot O, Taillandier L, et al. Radiotherapy for glioblastoma in the elderly. N Engl J Med. 2007;356(15):1527–35.

    Article  PubMed  CAS  Google Scholar 

  32. Roa W, Brasher PM, Bauman G, et al. Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol. 2004;22(9):1583–8.

    Article  PubMed  CAS  Google Scholar 

  33. Brandsma D, van den Bent MJ. Pseudoprogression and pseudoresponse in the treatment of gliomas. Curr Opin Neurol. 2009;22(6):633–8.

    Article  PubMed  Google Scholar 

  34. Malmstrom M, Gronberg BH, Stupp R, et al. Glioblastoma in elderly patients: a randomized controlled trial comparing survival in patients treated with 6-week radiotherapy versus hypofractionated RT over two weeks versus temozolomide single-agent chemotherapy. J Clin Oncol. 2010; Sep;18(S): LBA 2007.

  35. Wick W, Engel C, Combs S, et al. NOA-08 randomized phase III trial of 1-week-on/1-week-off temozolomide versus involved-field radiotherapy in elderly (older than age 65) patients with newly diagnosed anaplastic astrocytoma or glioblastoma (Methusalem). J Clin Oncol. 2010; Sep;18(S): LBA 2001.

  36. Minniti G, De Sanctis V, Muni R, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients. J Neurooncol. 2008;88(1):97–103.

    Article  PubMed  CAS  Google Scholar 

  37. Surveillance, Epidemiology and End Results Database: Brain cancer mortality trends in the U.S., 1997–2007. Available at http://www.seer.gov. Accessed December 2010.

  38. Barker CA, Chang M, Chou JF, et al. Concurrent temozolomide increases survival but incrases toxicity in elderly patients with glioblastoma multiforme treated with standard or abbreviated radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78(3):S167.

    Google Scholar 

  39. Brandes AA, Vastola F, Basso U, et al. A prospective study on glioblastoma in the elderly. Cancer. 2003;97(3):657–62.

    Article  PubMed  Google Scholar 

  40. Combs SE, Wagner J, Bischof M, et al. Postoperative treatment of primary glioblastoma multiforme with radiation and concomitant temozolomide in elderly patients. Int J Radiat Oncol Biol Phys. 2008;70(4):987–92.

    Article  PubMed  Google Scholar 

  41. Fiorica F, Berretta M, Colosimo C, et al. Glioblastoma in elderly patients: safety and efficacy of adjuvant radiotherapy with concomitant temozolomide. Arch Gerontol Geriatr. 2010;51(1):31–5.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

S. Yovino: none; S. Grossman: consultant to Merck and Lilly.

Author information

Authors and Affiliations

  1. The Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Suite 1 M-16, 1550 Orleans Street, Baltimore, MD, 21232, USA

    Susannah Yovino MD & Stuart A. Grossman MD

Authors
  1. Susannah Yovino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stuart A. Grossman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stuart A. Grossman MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yovino, S., Grossman, S.A. Treatment of Glioblastoma in “Elderly” Patients. Curr. Treat. Options in Oncol. 12, 253–262 (2011). https://doi.org/10.1007/s11864-011-0158-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-011-0158-0

Keywords

Search

Navigation