Skip to main content

Advertisement

SpringerLink
Log in

Treatment of Glioblastoma in the Elderly

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Clinical research in neuro-oncology frequently classifies patients over 60–70 years of age as ‘elderly’, a designation intended to identify patients with the disease characteristics, psychosocial changes, and susceptibility to treatment toxicities associated with advancing age. The elderly account for a large proportion of patients diagnosed with glioblastoma (GBM), and this population is projected to increase. Their prognosis is inferior to that of GBM patients as a whole, and concerns over treatment toxicity may limit the aggressiveness with which they are treated. Recent clinical studies have assisted with therapeutic decision making in this cohort. Hypofractionated radiation with concurrent and adjuvant temozolomide has been shown to increase survival without worsened quality of life in elderly patients with good functional status. Single modality radiation therapy or temozolomide therapy are frequently used in this population, and while neither has demonstrated superiority, O6-methylguanine–DNA methyltransferase (MGMT) methylation status is predictive of improved survival with temozolomide over radiation therapy. Despite these advances, ambiguity as to how to best define, assess, and treat this population remains. The specific response of elderly patients to emerging therapies, such as immunotherapies, is unclear. Advancing outcomes for elderly patients with GBM requires persistent efforts to include them in translational and clinical research endeavors, and concurrent dedication to the preservation of function and quality of life in this population.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ostrom QT, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro Oncol. 2013;15(Suppl 2):ii1–56.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Weller M, et al. Geriatric neuro-oncology: from mythology to biology. Curr Opin Neurol. 2011;24(6):599–604.

    Article  PubMed  Google Scholar 

  3. Townsley CA, et al. Evaluation of adverse events experienced by older patients participating in studies of molecularly targeted agents alone or in combination. Clin Cancer Res. 2006;12(7 Pt 1):2141–9.

    Article  PubMed  CAS  Google Scholar 

  4. Daste A, et al. Targeted therapy and elderly people: a review. Eur J Cancer. 2016;69:199–215.

    Article  PubMed  Google Scholar 

  5. Babu R, et al. Glioblastoma in the elderly: the effect of aggressive and modern therapies on survival. J Neurosurg. 2016;124(4):998–1007.

    Article  PubMed  CAS  Google Scholar 

  6. Nitsche U, Stoss C, Friess H. Effect of adjuvant chemotherapy on elderly colorectal cancer patients: lack of evidence. Gastrointest Tumors. 2017;4(1–2):11–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. Stummer W, et al. Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery. 2008;62(3):564–76 (discussion 564–76).

    Article  PubMed  Google Scholar 

  8. Porter KR, et al. Prevalence estimates for primary brain tumors in the United States by age, gender, behavior, and histology. Neuro-oncology. 2010;12(6):520–7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ohgaki H, Kleihues P. population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol. 2005;64(6):479–89.

    Article  PubMed  CAS  Google Scholar 

  10. Scott JG, et al. Aggressive treatment is appropriate for glioblastoma multiforme patients 70 years old or older: a retrospective review of 206 cases. Neuro-oncology. 2011;13(4):428–36.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Stupp R, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–96.

    Article  PubMed  CAS  Google Scholar 

  12. Kita D, et al. Age as a predictive factor in glioblastomas: population-based study. Neuroepidemiology. 2009;33(1):17–22.

    Article  PubMed  Google Scholar 

  13. Paszat L, et al. A population-based study of glioblastoma multiforme. Int J Radiat Oncol Biol Phys. 2001;51(1):100–7.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  15. Perry JR, et al. Short-course radiation plus temozolomide in elderly patients with glioblastoma. N Engl J Med. 2017;376(11):1027–37.

    Article  PubMed  CAS  Google Scholar 

  16. Wick W, et al. Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol. 2012;13(7):707–15.

    Article  PubMed  CAS  Google Scholar 

  17. Malmstrom A, et al. 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. 2012;13(9):916–26.

    Article  PubMed  CAS  Google Scholar 

  18. Minniti G, et al. Phase II study of short-course radiotherapy plus concomitant and adjuvant temozolomide in elderly patients with glioblastoma. Int J Radiat Oncol Biol Phys. 2012;83(1):93–9.

    Article  PubMed  CAS  Google Scholar 

  19. Ritz P. Physiology of aging with respect to gastrointestinal, circulatory and immune system changes and their significance for energy and protein metabolism. Eur J Clin Nutr. 2000;54(Suppl 3):S21–5.

    Article  PubMed  CAS  Google Scholar 

  20. Kinirons MT, O’Mahony MS. Drug metabolism and ageing. Br J Clin Pharmacol. 2004;57(5):540–4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Lipschitz DA, Udupa KB. Age and the hematopoietic system. J Am Geriatr Soc. 1986;34(6):448–54.

    Article  PubMed  CAS  Google Scholar 

  22. Meier-Ruge W, et al. Age-related white matter atrophy in the human brain. Ann N Y Acad Sci. 1992;673:260–9.

    Article  PubMed  CAS  Google Scholar 

  23. Sehl M, Sawhney R, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part II. Cancer J. 2005;11(6):461–73.

    Article  PubMed  Google Scholar 

  24. Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41(2):67–76.

    Article  PubMed  CAS  Google Scholar 

  25. Zarnett OJ, et al. Treatment of elderly patients with glioblastoma: a systematic evidence-based analysis. JAMA Neurol. 2015;72(5):589–96.

    Article  PubMed  Google Scholar 

  26. Ghosn M, et al. Physical Performance Test and Karnofsky Performance Status are unable to identify elderly cancer patients requiring a Comprehensive Geriatric Assessment. Eur Geriatr Med. 2015;6(5):427–32.

    Article  Google Scholar 

  27. Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40(9):922–35.

    Article  PubMed  CAS  Google Scholar 

  28. Stuck AE, et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342(8878):1032–6.

    Article  PubMed  CAS  Google Scholar 

  29. Verhaak RG, et al. Integrated genomic analysis identifies clinically relevant subtypes of glioblastoma characterized by abnormalities in PDGFRA, IDH1, EGFR, and NF1. Cancer Cell. 2010;17(1):98–110.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Lee Y, et al. Gene expression analysis of glioblastomas identifies the major molecular basis for the prognostic benefit of younger age. BMC Med Genom. 2008;1:52.

    Article  CAS  Google Scholar 

  31. Brennan CW, et al. The Somatic Genomic Landscape of Glioblastoma. Cell. 2013;155(2):462–77.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Jha P, et al. Characterization of molecular genetic alterations in GBMs highlights a distinctive molecular profile in young adults. Diagn Mol Pathol. 2011;20(4):225–32.

    Article  PubMed  CAS  Google Scholar 

  33. Wiestler B, et al. Malignant astrocytomas of elderly patients lack favorable molecular markers: an analysis of the NOA-08 study collective. Neuro Oncol. 2013;15(8):1017–26.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Noushmehr H, et al. Identification of a CpG island methylator phenotype that defines a distinct subgroup of glioma. Cancer Cell. 2010;17(5):510–22.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Baysan M, et al. G-cimp status prediction of glioblastoma samples using mrna expression data. PLoS One. 2012;7(11):e47839.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Agnihotri S, et al. Alkylpurine–DNA–N-glycosylase confers resistance to temozolomide in xenograft models of glioblastoma multiforme and is associated with poor survival in patients. J Clin Investig. 2012;122(1):253–66.

    Article  PubMed  CAS  Google Scholar 

  37. Gerstner ER, et al. MGMT methylation is a prognostic biomarker in elderly patients with newly diagnosed glioblastoma. Neurology. 2009;73(18):1509–10.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Hegi ME, et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med. 2005;352(10):997–1003.

    Article  PubMed  CAS  Google Scholar 

  39. Piccirilli M, et al. Treatment of glioblastoma multiforme in elderly patients. Clinico-therapeutic remarks in 22 patients older than 80 years. Tumori. 2006;92(2):98–103.

    PubMed  Google Scholar 

  40. Bozdag S, et al. Age-specific signatures of glioblastoma at the genomic, genetic, and epigenetic levels. PLoS One. 2013;8(4):e62982.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Ahuja N, Issa JP. Aging, methylation and cancer. Histol Histopathol. 2000;15(3):835–42.

    PubMed  CAS  Google Scholar 

  42. Fraga MF, Esteller M. Epigenetics and aging: the targets and the marks. Trends Genet. 2007;23(8):413–8.

    Article  PubMed  CAS  Google Scholar 

  43. Schindler G, et al. Analysis of BRAF V600E mutation in 1,320 nervous system tumors reveals high mutation frequencies in pleomorphic xanthoastrocytoma, ganglioglioma and extra-cerebellar pilocytic astrocytoma. Acta Neuropathol. 2011;121(3):397–405.

    Article  PubMed  CAS  Google Scholar 

  44. Kleinschmidt-DeMasters BK, Aisner DL, Birks DK, Foreman NK. Epithelioid GBMs show a high percentage of BRAFV600E mutation. Am J Surg Pathol. 2013;37(5):685–98.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Arita H, et al. A combination of TERT promoter mutation and MGMT methylation status predicts clinically relevant subgroups of newly diagnosed glioblastomas. Acta Neuropathol Commun. 2016;4(1):79.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. Francis JM, et al. EGFR variant heterogeneity in glioblastoma resolved through single-nucleus sequencing. Cancer Discov. 2014;4(8):956–71.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  47. Nazarenko I, et al. PDGF and PDGF receptors in glioma. Upsala J Med Sci. 2012;117(2):99–112.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Phillips JJ, et al. PDGFRA amplification is common in pediatric and adult high-grade astrocytomas and identifies a poor prognostic group in IDH1 mutant glioblastoma. Brain Pathol. 2013;23(5):565–73.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  49. Batchelor TT, 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 

  50. Srividya MR, et al. Age-dependent prognostic effects of EGFR/p53 alterations in glioblastoma: study on a prospective cohort of 140 uniformly treated adult patients. J Clin Pathol. 2010;63(8):687–91.

    Article  PubMed  CAS  Google Scholar 

  51. Shiraishi S, et al. Influence of p53 mutations on prognosis of patients with glioblastoma. Cancer. 2002;95(2):249–57.

    Article  PubMed  CAS  Google Scholar 

  52. Kreisl TN, et al. Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol. 2009;27(5):740–5.

    Article  PubMed  CAS  Google Scholar 

  53. Lai A, et al. Phase II study of bevacizumab plus temozolomide during and after radiation therapy for patients with newly diagnosed glioblastoma multiforme. J Clin Oncol. 2011;29(2):142–8.

    Article  PubMed  CAS  Google Scholar 

  54. Chinot OL, et al. Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. N Engl J Med. 2014;370(8):709–22.

    Article  PubMed  CAS  Google Scholar 

  55. Chen W, et al. Glioma cells escaped from cytotoxicity of temozolomide and vincristine by communicating with human astrocytes. Med Oncol. 2015;32(3):43.

    Article  PubMed  CAS  Google Scholar 

  56. Sin WC, et al. Astrocytes promote glioma invasion via the gap junction protein connexin43. Oncogene. 2016;35(12):1504–16.

    Article  PubMed  CAS  Google Scholar 

  57. Chen W, et al. Human astrocytes secrete IL-6 to promote glioma migration and invasion through upregulation of cytomembrane MMP14. Oncotarget. 2016;7(38):62425–38.

    PubMed  PubMed Central  Google Scholar 

  58. Verschoor CP, et al. Blood CD33(+)HLA-DR(−) myeloid-derived suppressor cells are increased with age and a history of cancer. J Leukoc Biol. 2013;93(4):633–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Noorbakhsh A, et al. Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis. J Neurosurg. 2014;120(1):31–9.

    Article  PubMed  Google Scholar 

  60. Ewelt C, et al. Glioblastoma multiforme of the elderly: the prognostic effect of resection on survival. J Neurooncol. 2011;103(3):611–8.

    Article  PubMed  Google Scholar 

  61. Chaichana KL, et al. Surgical outcomes for older patients with glioblastoma multiforme: preoperative factors associated with decreased survival. Clinical article. J Neurosurg. 2011;114(3):587–94.

    Article  PubMed  Google Scholar 

  62. Vuorinen V, et al. Debulking or biopsy of malignant glioma in elderly people—a randomised study. Acta Neurochir (Wien). 2003;145(1):5–10.

    Article  CAS  Google Scholar 

  63. Barker CA, et al. Concurrent temozolomide (TMZ) improves survival, but increases toxicity, in elderly patients with glioblastoma multiforme (GBM) treated with standard (STD) or abbreviated (ABR) radiotherapy (RT). Int J Radiat Oncol Biol Phys. 2010;78(3):S167.

    Article  Google Scholar 

  64. Menei P, et al. Biodegradable carmustine wafers (Gliadel) alone or in combination with chemoradiotherapy: the french experience. Ann Surg Oncol. 2010;17(7):1740–6.

    Article  PubMed  Google Scholar 

  65. Chibbaro S, et al. Neurosurgery and elderly: analysis through the years. Neurosurg Rev. 2010;34(2):229–34.

    Article  PubMed  Google Scholar 

  66. D’Amico RS, et al. The safety of surgery in elderly patients with primary and recurrent glioblastoma. World Neurosurg. 2015;84(4):913–9.

    Article  PubMed  Google Scholar 

  67. Flanigan PM, et al. Developing an algorithm for optimizing care of elderly patients with glioblastoma. Neurosurgery. 2018;82(1):64–75.

    Article  PubMed  Google Scholar 

  68. Liu YL, et al. Effect of temozolomide on survival in elderly patients with glioblastoma and impaired performance status: a propensity score-matching analysis. Onco Targets Ther. 2017;10:4029–35.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Walker MD, et al. Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med. 1980;303(23):1323–9.

    Article  PubMed  CAS  Google Scholar 

  70. Lawrence YR, et al. Early toxicity predicts long-term survival in high-grade glioma. Br J Cancer. 2011;104(9):1365–71.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  71. Roa W, 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 

  72. Wick W, et al. EORTC 26101 phase III trial exploring the combination of bevacizumab and lomustine in patients with first progression of a glioblastoma. J Clin Oncol. 2016;34(15 Suppl):2001.

    Article  Google Scholar 

  73. Taal W, et al. Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB trial): a randomised controlled phase 2 trial. Lancet Oncol. 2014;15(9):943–53.

    Article  PubMed  CAS  Google Scholar 

  74. Wick W, et al. Lomustine and bevacizumab in progressive glioblastoma. N Engl J Med. 2017;377(20):1954–63.

    Article  PubMed  CAS  Google Scholar 

  75. Piribauer M, et al. Feasibility and toxicity of CCNU therapy in elderly patients with glioblastoma multiforme. Anticancer Drugs. 2003;14(2):137–43.

    Article  PubMed  CAS  Google Scholar 

  76. Nghiemphu PL, et al. Bevacizumab and chemotherapy for recurrent glioblastoma: a single-institution experience. Neurology. 2009;72(14):1217–22.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  77. Tabouret E, et al. Limited impact of prognostic factors in patients with recurrent glioblastoma multiforme treated with a bevacizumab-based regimen. J Neurooncol. 2013;114(2):191–8.

    Article  PubMed  CAS  Google Scholar 

  78. Tomihara K, Curiel TK, Zhang B. Optimization of immunotherapy in elderly cancer patients. Crit Rev Oncog. 2013;18(6):573–83.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Daste A, et al. Immune checkpoint inhibitors and elderly people: a review. Eur J Cancer. 2017;82:155–66.

    Article  PubMed  CAS  Google Scholar 

  80. Effros RB, Walford RL. The immune response of aged mice to influenza: diminished T-cell proliferation, interleukin 2 production and cytotoxicity. Cell Immunol. 1983;81(2):298–305.

    Article  PubMed  CAS  Google Scholar 

  81. Weng N-P, Akbar AN, Goronzy J. CD28(−) T cells: their role in the age-associated decline of immune function. Trends Immunol. 2009;30(7):306–12.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  82. Frasca D, et al. Age effects on B cells and humoral immunity in humans. Ageing Res Rev. 2011;10(3):330–5.

    Article  PubMed  CAS  Google Scholar 

  83. Garg SK, et al. Aging is associated with increased regulatory T-cell function. Aging Cell. 2014;13(3):441–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  84. Gupta S, Agrawal A. Inflammation & autoimmunity in human ageing: dendritic cells take a center stage. Indian J Med Res. 2013;138(5):711–6.

    PubMed  PubMed Central  CAS  Google Scholar 

  85. Hazeldine J, Lord JM. The impact of ageing on natural killer cell function and potential consequences for health in older adults. Ageing Res Rev. 2013;12(4):1069–78.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  86. Chiarion Sileni V, et al. Efficacy and safety of ipilimumab in elderly patients with pretreated advanced melanoma treated at Italian centres through the expanded access programme. J Exp Clin Cancer Res. 2014;33:30.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  87. Singh H, et al. FDA subset analysis of the safety of nivolumab in elderly patients with advanced cancers [abstract no. 10010]. J Clin Oncol. 2016;34(15 suppl):10010.

    Article  Google Scholar 

  88. Sampson JH, et al. Preliminary safety and activity of nivolumab and its combination with ipilimumab in recurrent glioblastoma (GBM): CHECKMATE-143. J Clin Oncol. 2015;33(15 Suppl):3010.

    Google Scholar 

  89. Reardon DA, et al. OS10.3 randomized phase 3 study evaluating the efficacy and safety of nivolumab vs bevacizumab in patients with recurrent glioblastoma: CheckMate 143. Neuro-oncology. 2017;19(Suppl 3):iii21.

    Article  PubMed Central  Google Scholar 

  90. Gheihman G, et al. Depression and hopelessness in patients with acute leukemia: the psychological impact of an acute and life-threatening disorder. Psychooncology. 2016;25(8):979–89.

    Article  PubMed  Google Scholar 

  91. Beckert AK, Duthie EH. The wrath of steroids in elderly patients with pulmonary diseases. Curr Geriatr Rep. 2016;5(2):124–31.

    Article  Google Scholar 

  92. Ge L, Mordiffi SZ. Factors associated with higher caregiver burden among family caregivers of elderly cancer patients: a systematic review. Cancer Nurs. 2017;40(6):471–8.

    Article  PubMed  Google Scholar 

  93. Huang ME, Cifu DX, Keyser-Marcus L. Functional outcomes in patients with brain tumor after inpatient rehabilitation: comparison with traumatic brain injury. Am J Phys Med Rehabil. 2000;79(4):327–35.

    Article  PubMed  CAS  Google Scholar 

  94. Spoletini I, et al. Depression and cancer: an unexplored and unresolved emergent issue in elderly patients. Crit Rev Oncol Hematol. 2008;65(2):143–55.

    Article  PubMed  Google Scholar 

  95. Colleoni M, et al. Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet. 2000;356(9238):1326–7.

    Article  PubMed  CAS  Google Scholar 

  96. Boele FW, et al. Psychiatric symptoms in glioma patients: from diagnosis to management. Neuropsychiatr Dis Treat. 2015;11:1413–20.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.

    Article  PubMed  CAS  Google Scholar 

  98. Ferris FD, et al. Palliative cancer care a decade later: accomplishments, the need, next steps—from the American Society of Clinical Oncology. J Clin Oncol. 2009;27(18):3052–8.

    Article  PubMed  Google Scholar 

  99. Jerant AF, et al. The TLC model of palliative care in the elderly: preliminary application in the assisted living setting. Ann Fam Med. 2004;2(1):54–60.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Pace A, Villani V. Palliative and Supportive Care of Patients with Intracranial Glioma. Prog Neurol Surg. 2018;31:229–37.

    Article  PubMed  Google Scholar 

  101. Pompili A, et al. Home palliative care and end of life issues in glioblastoma multiforme: results and comments from a homogeneous cohort of patients. Neurosurg Focus. 2014;37(6):E5.

    Article  PubMed  Google Scholar 

  102. Diamond EL, et al. Frequency and predictors of acute hospitalization before death in patients with glioblastoma. J Pain Symptom Manag. 2017;53(2):257–64.

    Article  Google Scholar 

  103. Diamond EL, et al. Rates and risks for late referral to hospice in patients with primary malignant brain tumors. Neuro-oncology. 2016;18(1):78–86.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0431, Houston, TX, 77030, USA

    Rebecca A. Harrison & John F. de Groot

Authors
  1. Rebecca A. Harrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John F. de Groot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rebecca A. Harrison.

Ethics declarations

Funding

No external funding was used in the preparation of this manuscript.

Conflict of interest

Rebecca A. Harrison and John F. de Groot declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harrison, R.A., de Groot, J.F. Treatment of Glioblastoma in the Elderly. Drugs Aging 35, 707–718 (2018). https://doi.org/10.1007/s40266-018-0568-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-018-0568-9

Search

Navigation