Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor in adults, and over half of patients with newly diagnosed GBM are over the age of 65. Management of glioblastoma in older patients includes maximal safe resection followed by either radiation, chemotherapy, or combined modality treatment. Despite recent advances in the treatment of older patients with GBM, survival is still only approximately 9 months compared to approximately 15 months for the general adult population, suggesting that further research is required to optimize management in the older population. The Comprehensive Geriatric Assessment (CGA) has been shown to have a prognostic and predictive role in the management of older patients with other cancers, and domains of the CGA have demonstrated an association with outcomes in GBM in retrospective studies. Furthermore, the CGA and other geriatric assessment tools are now starting to be prospectively investigated in older GBM populations. This review aims to outline current treatment strategies for older patients with GBM, explore the rationale for inclusion of geriatric assessment in GBM management, and highlight recent data investigating its implementation into practice.
Highlights
Glioblastoma (GBM) is the most common and most lethal primary brain tumor in adults
Index (PNI), Charlson Comorbidity Index (CCI), Frailty Index (FI), along with other clinicopathologic factors, they confirmed previous findings suggesting high Karnofsky performance status (KPS) and gross total resection were significantly associated with better overall survival (OS)
The main predictors of survival are age, performance status, and MGMT methylation status, and it is upon these factors that the majority of current treatment algorithms are based
Summary
Glioblastoma (GBM) is the most common and most lethal primary brain tumor in adults. Over half of patients with newly diagnosed GBM are over age 65 [1,2] with a peak incidence between 75 and 84 years [3], and as the global population ages, incidence rates continue to increase [4]. Age and performance status have consistently been shown to be negative prognostic factors [7], and clearly influence treatment decisions Other factors such as tumor biology, comorbid conditions, polypharmacy, reduced treatment tolerance, and socioeconomic status may influence prognosis for older cancer patients. Chronologic age is becoming less validated as a marker of treatment tolerability, patients over age 65 are typically categorized as older adults, and their treatment considerations are unique relative to the general adult population [10] Given these considerations and the paucity of randomized clinical trials involving older GBM patients until relatively recently, there has been uncertainty regarding optimal treatment such that nearly 30% of patients over age 65 receive no treatment or less than standard of care [11,12]. We will review current treatment strategies for older patients with newly diagnosed GBM and explore the rationale for incorporating geriatric assessment into GBM management, along with recent data looking at its implementation
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