title: Primary brain tumors in the elderly.
abstract: The incidence of primary brain tumors is highest in elderly patients, and advanced age often is a negative prognostic factor. Nevertheless, large randomized studies in this population are scarce. Elderly patients with primary brain tumors also present unique challenges, such as the presence of multiple comorbidities and polypharmacy, decreased tolerance to chemotherapy, and an increased risk for radiation-induced neurotoxicity. This review gives an overview of the treatment options for older patients with glioblastoma and other gliomas, primary central nervous system lymphomas (PCNSLs), and meningiomas. Selected elderly glioblastoma patients with good performance status may benefit from aggressive treatment with surgical resection, radiotherapy, and possibly chemotherapy. For older patients with PCNSLs, high-dose methotrexate-based chemotherapy should be the mainstay option; whole-brain radiation therapy should be avoided in chemosensitive tumors because of the high risk of irreversible and progressive neurotoxicity. Meningiomas often may be followed up in elderly patients, as they usually are asymptomatic and have a slow growth rate. Treatment for elderly patients with primary brain tumors should be individualized, and age alone should not preclude the use of more aggressive treatments.
authors.affiliation: Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. nayakl@mskcc.org
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Nayak
authors.forename: Fabio M
authors.initials: FM
authors.lastname: Iwamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans; D016896:Treatment Outcome
references.citation: Int J Radiat Oncol Biol Phys. 1992;23(1):9-17
references.pmid: 1572835
references.citation: J Neurooncol. 1998 Aug;39(1):65-70
references.pmid: 9760071
references.citation: J Neurosurg. 2009 Jan;110(1):156-62
references.pmid: 18847342
references.citation: Int J Radiat Oncol Biol Phys. 2008 Mar 15;70(4):987-92
references.pmid: 17967509
references.citation: Acta Neurochir (Wien). 2003 Jan;145(1):5-10
references.pmid: 12545256
references.citation: N Engl J Med. 2005 Mar 10;352(10):987-96
references.pmid: 15758009
references.citation: J Clin Oncol. 2009 Oct 1;27(28):4733-40
references.pmid: 19720927
references.citation: Cancer Res. 2001 Feb 1;61(3):1122-8
references.pmid: 11221842
references.citation: Cancer. 2003 Feb 1;97(3):657-62
references.pmid: 12548608
references.citation: Crit Rev Oncol Hematol. 2006 Dec;60(3):256-66
references.pmid: 17027278
references.citation: Cancer. 1993 Apr 15;71(8):2585-97
references.pmid: 8453582
references.citation: Arch Pathol Lab Med. 2005 May;129(5):624-31
references.pmid: 15859633
references.citation: J Neurol Neurosurg Psychiatry. 2000 Jan;68(1):25-8
references.pmid: 10601396
references.citation: Lancet. 2005 Sep 17-23;366(9490):985-90
references.pmid: 16168780
references.citation: Int J Radiat Oncol Biol Phys. 2001 Sep 1;51(1):100-7
references.pmid: 11516858
references.citation: Cancer. 2009 Aug 15;115(16):3758-66
references.pmid: 19484785
references.citation: Int J Radiat Oncol Biol Phys. 1979 Oct;5(10):1725-31
references.pmid: 231022
references.citation: Neuro Oncol. 2009 Apr;11(2):211-5
references.pmid: 18757775
references.citation: Neurosurgery. 2003 Jul;53(1):62-70; discussion 70-1
references.pmid: 12823874
references.citation: Clin Cancer Res. 2004 Jan 1;10(1 Pt 1):228-33
references.pmid: 14734474
references.citation: J Clin Oncol. 2000 Sep;18(17):3144-50
references.pmid: 10963643
references.citation: Cancer. 2003 May 1;97(9):2262-6
references.pmid: 12712481
references.citation: J Neurooncol. 2007 Nov;85(2):207-11
references.pmid: 17896079
references.citation: J Clin Oncol. 2009 Feb 10;27(5):740-5
references.pmid: 19114704
references.citation: Neuro Oncol. 2010 Feb;12(2):164-72
references.pmid: 20150383
references.citation: Cancer. 2007 Sep 15;110(6):1338-44
references.pmid: 17647247
references.citation: J Neurooncol. 2008 Aug;89(1):97-103
references.pmid: 18398569
references.citation: Cancer. 2002 Oct 1;95(7):1504-10
references.pmid: 12237919
references.citation: J Clin Oncol. 2003 Jul 15;21(14):2726-31
references.pmid: 12860951
references.citation: Neurology. 2009 Apr 7;72(14):1217-22
references.pmid: 19349600
references.citation: Ann Neurol. 2008 Dec;64(6):628-34
references.pmid: 19107984
references.citation: N Engl J Med. 2007 Apr 12;356(15):1527-35
references.pmid: 17429084
references.citation: Cancer. 2004 May 15;100(10):2208-14
references.pmid: 15139066
references.citation: J Neurooncol. 2008 May;88(1):97-103
references.pmid: 18250965
references.citation: J Clin Oncol. 2006 Dec 20;24(36):5711-5
references.pmid: 17116938
references.citation: Neurology. 2009 Dec 15;73(24):2093-8
references.pmid: 19907009
references.citation: J Neurooncol. 2009 Jan;91(1):95-100
references.pmid: 18758912
references.citation: Lancet. 2002 Mar 23;359(9311):1011-8
references.pmid: 11937180
references.citation: Neuro Oncol. 2002 Oct;4(4):278-99
references.pmid: 12356358
references.citation: Neurology. 1997 May;48(5):1459-62
references.pmid: 9153494
references.citation: Neurosurgery. 2005 Nov;57(5):866-72; discussion 866-72
references.pmid: 16284557
references.citation: Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):835-9
references.pmid: 8040031
references.citation: J Neurosurg. 1978 Sep;49(3):333-43
references.pmid: 355604
references.citation: Neuroepidemiology. 2009;33(1):17-22
references.pmid: 19325245
references.citation: J Clin Oncol. 2004 May 1;22(9):1583-8
references.pmid: 15051755
references.citation: J Clin Oncol. 2002 Dec 15;20(24):4643-8
references.pmid: 12488408
references.citation: Cancer. 2009 Dec 1;115(23):5534-40
references.pmid: 19708033