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Should radiotherapy be standard therapy for
brain tumors in the elderly? Cons
Chinot OL
Unite de Neuro-Oncologie, Service de Neurochirurgie, CHU Timone,
264, rue Saint Pierre, 13385 Marseille Cedex 05 France.
Elderly patients with malignant gliomas present unique treatment
challenges.
Data are limited on the efficacy of various treatment modalities for high-grade
gliomas in the elderly patient population, particularly for patients over 70
years of age, and the most appropriate treatment strategies remain a matter of
debate.
These patients generally have a poor clinical course and lower tolerance to
therapy compared with younger patients.
Standard radiotherapy (RT) may provide a survival benefit for patients with a
good Karnofsky performance status (>/=70); however, RT is associated with
significant neurologic toxicity in elderly patients.
Some argue that the apparent modest clinical benefits of RT do not outweigh the
risks and inconvenience of the standard schedule.
Clearly, more effective and better-tolerated treatments are needed.
Chemotherapy agents with good safety profiles, such as oral temozolomide
(Temodar [US], Temodal [international]; Schering-Plough Corporation, Kenilworth,
NJ), are being considered as alternatives to RT.
When used as single-agent therapy, temozolomide induced objective responses and
improved neurologic status in elderly patients with newly diagnosed, unresected
glioblastoma.
For patients with good performance status, treatment options should be discussed
and the risks and potential benefits of RT carefully considered.
Furthermore, prospective randomized studies should be performed to define the
best therapeutic option for efficacy, toxicity, convenience, and quality of
life.
PMID: 14765390 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14765390
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