Neuro-Oncology Neuro-Oncology 16(11), 1459– 1468, 2014 doi:10.1093/neuonc/nou063 Advance Access date 2 May 2014
Assessment and treatment relevance in elderly glioblastoma patients Luc Bauchet, Sonia Zouaoui, Ame´lie Darlix, Nicolas Menjot de Champfleur, Ernestine Ferreira, Michel Fabbro, Christine Kerr, and Luc Taillandier
Corresponding Author: Luc Bauchet, MD, PhD, Department of Neurosurgery, Hoˆpital Gui de Chauliac, Centre Hospitalier Universitaire, 80 Avenue Augustin Fliche, 34 295 Montpellier cedex 5, France. ([email protected]).
Glioblastoma (GBM) is the most common malignant primary brain tumor. Its incidence continues to increase in the elderly because the older segment of the population is growing faster than any other age group. Most clinical studies exclude elderly patients, and “standards of care” do not exist for GBM patients aged .70 years. We review epidemiology, tumor biology/molecular factors, prognostic factors (clinical, imaging data, therapeutics), and their assessments as well as classic and specific endpoints plus recent and ongoing clinical trials for elderly GBM patients. This work includes perspectives and personal opinions on this topic. Although there are no standards of care for elderly GBM patients, we can hypothesize that (i) Karnofsky performance status (KPS), probably after steroid treatment, is one of the most important clinical factors for determining our oncological strategy; (ii) resection is superior to biopsy, at least in selected patients (depending on location of the tumor and associated comorbidities); (iii) specific schedules of radiotherapy yield a modest but significant improvement; (iv) temozolomide has an acceptable tolerance, even when KPS
Assessment and treatment relevance in elderly glioblastoma patients Luc Bauchet, Sonia Zouaoui, Ame´lie Darlix, Nicolas Menjot de Champfleur, Ernestine Ferreira, Michel Fabbro, Christine Kerr, and Luc Taillandier
Corresponding Author: Luc Bauchet, MD, PhD, Department of Neurosurgery, Hoˆpital Gui de Chauliac, Centre Hospitalier Universitaire, 80 Avenue Augustin Fliche, 34 295 Montpellier cedex 5, France. ([email protected]).
Glioblastoma (GBM) is the most common malignant primary brain tumor. Its incidence continues to increase in the elderly because the older segment of the population is growing faster than any other age group. Most clinical studies exclude elderly patients, and “standards of care” do not exist for GBM patients aged .70 years. We review epidemiology, tumor biology/molecular factors, prognostic factors (clinical, imaging data, therapeutics), and their assessments as well as classic and specific endpoints plus recent and ongoing clinical trials for elderly GBM patients. This work includes perspectives and personal opinions on this topic. Although there are no standards of care for elderly GBM patients, we can hypothesize that (i) Karnofsky performance status (KPS), probably after steroid treatment, is one of the most important clinical factors for determining our oncological strategy; (ii) resection is superior to biopsy, at least in selected patients (depending on location of the tumor and associated comorbidities); (iii) specific schedules of radiotherapy yield a modest but significant improvement; (iv) temozolomide has an acceptable tolerance, even when KPS
