Treatment options and outcomes for glioblastoma in the elderly patient

Nils D Arvold,1 David A Reardon2 1Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA; 2Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA Abstract: Age remains the most powerful prognostic factor am...

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Autores principales:	Arvold ND, Reardon DA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	glioblastoma elderly radiotherapy hypofractionated temozolomide MGMT Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/12d3aff601e241ddbe0edaccc7c79307
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spelling	oai:doaj.org-article:12d3aff601e241ddbe0edaccc7c793072021-12-02T11:16:00ZTreatment options and outcomes for glioblastoma in the elderly patient1178-1998https://doaj.org/article/12d3aff601e241ddbe0edaccc7c793072014-02-01T00:00:00Zhttps://www.dovepress.com/treatment-options-and-outcomes-for-glioblastoma-in-the-elderly-patient-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Nils D Arvold,1 David A Reardon2 1Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA; 2Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA Abstract: Age remains the most powerful prognostic factor among glioblastoma (GBM) patients. Half of all patients with GBM are aged 65 years or older at the time of diagnosis, and the incidence rate of GBM in patients aged over 65 years is increasing rapidly. Median survival for elderly GBM patients is less than 6 months and reflects less favorable tumor biologic factors, receipt of less aggressive care, and comorbid disease. The standard of care for elderly GBM patients remains controversial. Based on limited data, extensive resection appears to be more beneficial than biopsy. For patients with favorable Karnofsky performance status (KPS), adjuvant radiotherapy (RT) has a demonstrated survival benefit with no observed decrement in quality of life. Concurrent and adjuvant temozolomide (TMZ) along with RT to 60 Gy have not been prospectively studied among patients aged over 70 years but should be considered for patients aged 65–70 years with excellent KPS. Based on the recent NOA-08 and Nordic randomized trials, testing for O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation should be performed routinely immediately after surgery to aid in adjuvant treatment decisions. Patients aged over 70 years with favorable KPS, or patients aged 60–70 years with borderline KPS, should be considered for monotherapy utilizing standard TMZ dosing for patients with MGMT-methylated tumors, and hypofractionated RT (34 Gy in ten fractions or 40 Gy in 15 fractions) for patients with MGMT-unmethylated tumors. The ongoing European Organisation for Research and Treatment of Cancer/National Cancer Institute of Canada trial will help clarify the role for concurrent TMZ with hypofractionated RT. For elderly patients with poor KPS, reasonable options include best supportive care, TMZ alone, hypofractionated RT alone, or whole brain RT for symptomatic patients needing to start treatment urgently. Given the balance between short survival and quality of life in this patient population, optimal management of elderly GBM patients must be made individually according to patient age, MGMT methylation status, performance score, and patient preferences. Keywords: glioblastoma, elderly, radiotherapy, hypofractionated, temozolomide, MGMTArvold NDReardon DADove Medical PressarticleglioblastomaelderlyradiotherapyhypofractionatedtemozolomideMGMTGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 357-367 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	glioblastoma elderly radiotherapy hypofractionated temozolomide MGMT Geriatrics RC952-954.6
spellingShingle	glioblastoma elderly radiotherapy hypofractionated temozolomide MGMT Geriatrics RC952-954.6 Arvold ND Reardon DA Treatment options and outcomes for glioblastoma in the elderly patient
description	Nils D Arvold,1 David A Reardon2 1Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA; 2Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA Abstract: Age remains the most powerful prognostic factor among glioblastoma (GBM) patients. Half of all patients with GBM are aged 65 years or older at the time of diagnosis, and the incidence rate of GBM in patients aged over 65 years is increasing rapidly. Median survival for elderly GBM patients is less than 6 months and reflects less favorable tumor biologic factors, receipt of less aggressive care, and comorbid disease. The standard of care for elderly GBM patients remains controversial. Based on limited data, extensive resection appears to be more beneficial than biopsy. For patients with favorable Karnofsky performance status (KPS), adjuvant radiotherapy (RT) has a demonstrated survival benefit with no observed decrement in quality of life. Concurrent and adjuvant temozolomide (TMZ) along with RT to 60 Gy have not been prospectively studied among patients aged over 70 years but should be considered for patients aged 65–70 years with excellent KPS. Based on the recent NOA-08 and Nordic randomized trials, testing for O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation should be performed routinely immediately after surgery to aid in adjuvant treatment decisions. Patients aged over 70 years with favorable KPS, or patients aged 60–70 years with borderline KPS, should be considered for monotherapy utilizing standard TMZ dosing for patients with MGMT-methylated tumors, and hypofractionated RT (34 Gy in ten fractions or 40 Gy in 15 fractions) for patients with MGMT-unmethylated tumors. The ongoing European Organisation for Research and Treatment of Cancer/National Cancer Institute of Canada trial will help clarify the role for concurrent TMZ with hypofractionated RT. For elderly patients with poor KPS, reasonable options include best supportive care, TMZ alone, hypofractionated RT alone, or whole brain RT for symptomatic patients needing to start treatment urgently. Given the balance between short survival and quality of life in this patient population, optimal management of elderly GBM patients must be made individually according to patient age, MGMT methylation status, performance score, and patient preferences. Keywords: glioblastoma, elderly, radiotherapy, hypofractionated, temozolomide, MGMT
format	article
author	Arvold ND Reardon DA
author_facet	Arvold ND Reardon DA
author_sort	Arvold ND
title	Treatment options and outcomes for glioblastoma in the elderly patient
title_short	Treatment options and outcomes for glioblastoma in the elderly patient
title_full	Treatment options and outcomes for glioblastoma in the elderly patient
title_fullStr	Treatment options and outcomes for glioblastoma in the elderly patient
title_full_unstemmed	Treatment options and outcomes for glioblastoma in the elderly patient
title_sort	treatment options and outcomes for glioblastoma in the elderly patient
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/12d3aff601e241ddbe0edaccc7c79307
work_keys_str_mv	AT arvoldnd treatmentoptionsandoutcomesforglioblastomaintheelderlypatient AT reardonda treatmentoptionsandoutcomesforglioblastomaintheelderlypatient
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Treatment options and outcomes for glioblastoma in the elderly patient

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