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