Treatment of glioblastoma in older patients

The incidence of glioblastoma in the elderly population has increased in recent decades. Current treatment of glioblastoma in the elderly includes surgery, radiotherapy and chemotherapy; however, its optimal management is still a matter of debate. Several studies have reported longer survival after extensive resection in comparison with biopsy only, but the survival advantage remains modest. Both standard (60 Gy in 30 fractions over 6 weeks) and abbreviated courses of radiotherapy (30-50 Gy in 6-20 fractions over 2-4 weeks) have been employed in elderly patients with glioblastoma with survival benefits compared with supportive care alone. Temozolomide is an alkylating agent that has been used more recently as an alternative, effective and safe therapy in older patients with newly diagnosed glioblastoma. The addition of concomitant and/or adjuvant chemotherapy with temozolomide to radiotherapy, which is currently the standard treatment in adults with glioblastoma, is emerging as a feasible therapeutic option for older patients with favorable prognostic factors; however, the impact of different schedules of radiotherapy plus temozolomide on survival and quality of life in this population needs to be addressed in future randomized studies. © 2009 Future Medicine Ltd.