Management Strategies for Glioblastoma in Elderly Patients
Summary
Glioblastoma in elderly patients presents a unique therapeutic challenge, balancing maximal tumour control against the risks of treatment‐related toxicity and functional decline. Optimal management typically comprises a multimodal approach, beginning with surgical assessment to determine resectability and performance status. Where feasible, gross total resection offers modest survival benefits, although biopsy alone may be preferred in frail individuals. Postoperative care centres on radiotherapy, with evidence supporting both conventionally fractionated courses and shorter hypofractionated regimens to reduce treatment burden without compromising outcomes. Concurrent and adjuvant temozolomide remains the cornerstone of chemotherapy for patients with favourable molecular markers, notably methylation of the O6-methylguanine-DNA methyltransferase promoter, which predicts enhanced responsiveness. Novel strategies under investigation include combination approaches with DNA repair inhibitors, immunotherapeutic agents and tumour‐treating fields, all aimed at overcoming inherent resistance mechanisms. Geriatric assessment tools and prognostic nomograms are increasingly employed to personalise treatment intensity, taking into account comorbidities, cognitive function and anticipated quality of life. Supportive measures—encompassing corticosteroid management, seizure control and rehabilitation—are integral to preserving independence. Collectively, these strategies strive to extend survival while maintaining functional status and minimising hospital visits, reflecting a patient‐centred paradigm in the care of older adults with glioblastoma.
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Management Strategies for Glioblastoma in Elderly Patients publication trend
The graph below shows the total number of articles in management strategies for glioblastoma in elderly patients across all publications each year (not limited to Nature Index journals).
Technical terms
Glioblastoma: The most aggressive primary brain tumour in adults, characterised by rapid growth and resistance to therapy.
Hypofractionated Radiotherapy: A radiation schedule delivering larger doses per fraction over fewer sessions, reducing overall treatment time.
Temozolomide: An oral alkylating chemotherapy agent that crosses the blood–brain barrier and is standard in glioblastoma management.
MGMT Promoter Methylation: Epigenetic silencing of the DNA repair enzyme gene O6-methylguanine-DNA methyltransferase, associated with improved response to alkylating agents.
PARP Inhibitor: A targeted agent that impairs DNA repair by inhibiting poly (ADP-ribose) polymerase enzymes, enhancing radiosensitivity.
References
- Concurrent Olaparib and Radiation Therapy in Older Patients With Newly Diagnosed Glioblastoma: The Phase 1 Dose-Escalation PARADIGM Trial. International Journal of Radiation Oncology • Biology • Physics (2024).
- Hypofractionation in Glioblastoma: An Overview of Palliative, Definitive, and Exploratory Uses. Cancers (2023).
- Radiotherapy plus temozolomide in elderly patients with glioblastoma: a “real-life” report. Radiation Oncology (2017).
- Gross Total vs. Subtotal Resection on Survival Outcomes in Elderly Patients With High-Grade Glioma: A Systematic Review and Meta-Analysis. Frontiers in Oncology (2020).
- Development and external validation of dual online tools for prognostic assessment in elderly patients with high-grade glioma: a comprehensive study using SEER and Chinese cohorts. Frontiers in Endocrinology (2023).
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