[Elderly patients with glioblastoma: state of the art].
The incidence of glioblastoma increases with age, with a median age, at diagnosis, of 65 years. Indeed, the optimization of standard of care of elderly glioblastoma patients in an aging population in Western countries becomes crucial. The age remains the main prognostic factor of glioblastoma. Survival among elderly patients is significantly less than among younger patients. The median survival of elderly glioblastoma patients is generally inferior to 6 months. More aggressive tumor behavior, less aggressive treatments, increased toxicity of therapies and more unfavorable clinical factors and comorbidities could explain a higher severity of the disease in the elderly. The balance between treatment efficacy and quality of life is a major focus because of the shorter life expectancy of patients. The standard of care of glioblastoma in elderly patients remains controversial. Large optimal resection, when achievable, should be preferred to biopsy. Survival is longer after adjuvant radiotherapy, either normofractionated over 6-weeks course or hypofractionated over 3-weeks course, for patients with good clinical status. Hypofractionation is often preferred because of shorter procedure. Chemotherapy alone with temozolomide can be proposed to patients with methylated MGMT promoter. A phase III randomized study, testing short-course adjuvant radiotherapy with or without temozolomide in elderly patients with good clinical status, is ongoing.
Clermont université, EA7283 CREaT, centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France; Institut Curie, UMR CNRS 3347/Inserm U1021, équipe recombinaison, réparation et cancer, 91400 Paris-Orsay, France. Electronic address: Julian.biau@cjp.fr.
Julian
J
Biau
Centre Jean-Perrin, département d'oncologie médicale, 63011 Clermont-Ferrand, France.
Pierre
P
Dalloz
Inserm U501, centre d'investigation clinique, Clermont université, EA7283 CREaT, centre Jean-Perrin, département d'oncologie médicale, 63011 Clermont-Ferrand, France.
Xavier
X
Durando
CHU, département d'oncogériatrie, centre Jean-Perrin, département d'oncologie médicale , 63011 Clermont-Ferrand, France.
Marie-Odile
MO
Hager
Clermont université, EA7283 CREaT, centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
Zangbéwendé Guy
ZG
Ouédraogo
Clermont université, CHU Gabriel-Montpied, service de neurochirurgie, EA7282, 63011 Clermont-Ferrand, France.
Toufic
T
Khalil
Clermont université, CHU Gabriel-Montpied, service de neurochirurgie, EA7282, 63011 Clermont-Ferrand, France.
Jean-Jacques
JJ
Lemaire
Clermont université, EA7283 CREaT, centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
Emmanuel
E
Chautard
Clermont université, EA7283 CREaT, centre Jean-Perrin, département de radiothérapie, 58, rue Montalembert, 63011 Clermont-Ferrand, France.
Pierre
P
Verrelle
D000367:Age Factors; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005909:Glioblastoma / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D006801:Humans; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D000077204:Temozolomide
D061067:Antibodies, Monoclonal, Humanized; D018906:Antineoplastic Agents, Alkylating; D000068258:Bevacizumab; D003606:Dacarbazine; D000077204:Temozolomide
Elderly; Glioblastoma; Glioblastome; Hypofractionation; Hypofractionnement; Personne âgée; Radiotherapy; Radiothérapie; Temozolomide; Témozolomide