Radiotherapy for malignant gliomas in the elderly.
While fractionated external beam radiotherapy remains the principal treatment in patients with histologically verified malignant glioma, its use in older patients and in patients with adverse prognostic features has not been subject to randomized studies. Hypofractionated partial brain irradiation offers a short, well-tolerated treatment with a palliative benefit for patients with a predicted median survival of less than 6 months. To assess its true efficacy in terms of survival and quality-of-life gain requires a formal randomized comparison with supportive care either alone or in combination with palliative chemotherapy and with radical radiotherapy. On present evidence, palliative radiotherapy remains the appropriate treatment for older patients and those with adverse prognostic features, but the final choice should be based on the patient's wishes moderated by the clinician's perception of the gain of treatment.
Brada
Michael
M
The Institute of Cancer Research and The Royal Marsden NHS Trust, Downs Road, Sutton, Surrey, UK.
Stenning
Sally Patricia
SP
D000206:Actuarial Analysis; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D003657:Decision Making; D019583:Dose Fractionation, Radiation; D005910:Glioma / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D015996:Survival Rate