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The treatment of elderly patients with
high-grade gliomas
Brandes AA, Monfardini S
Medical Oncology Department, Azienda Ospedale-Universita, Padova,
Italy.
Elderly patients with cancer are frequently excluded from cancer therapy trials,
treated suboptimally, or not treated at all because of the widely held belief
that elderly patients do not tolerate chemotherapy and/or radiotherapy (RT) as
well as younger patients.
Excluding elderly patients from conventional treatment, chemotherapy in
particular, is often based on ad hoc decisions rather than on sound scientific
data.
Malignant gliomas are the most common primary brain tumors in adults, and the
age-adjusted incidence of high-grade gliomas has increased over recent years,
especially in the elderly.
However, few investigators focus on the treatment of high-grade gliomas in the
elderly.
Data from retrospective studies and meta-analyses suggest that elderly patients
with high-grade gliomas have a poorer outcome than younger patients, possibly
because of the presence of comorbidity, resistance to cancer therapy, genetic
aberrations, different histology, neurodegeneration, or age
discrimination.
The optimal treatment of elderly patients with high-grade gliomas has not been
determined.
Surgical debulking and postoperative RT are associated with a significant
increase in survival among elderly patients who are in good clinical
condition.
A recent report has shown that treatment with temozolomide (Temodar [US],
Temodal [international]; Schering-Plough Corporation, Kenilworth, NJ) plus RT
provides a significant survival benefit compared with RT alone and a
significantly improved time to progression compared with RT plus standard
chemotherapy (lomustine, procarbazine, and vincristine).
Further, temozolomide was well tolerated in the elderly patient population and
was less toxic than standard chemotherapy.
Therefore, it could be recommended that a full course of RT be followed by
adjuvant temozolomide in elderly patients with good prognostic factors.
Further, temozolomide alone could be considered as a treatment option for
elderly patients with glioblastoma with poorer performance status and for
patients who cannot tolerate RT.
Results from larger prospective trials will determine the optimal role of
chemotherapy, particularly temozolomide, in elderly patients with malignant
gliomas.
PMID: 14765388 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14765388
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