Managing Glioblastoma in the Elderly Patient: New Opportunities.

Managing elderly patients with glioblastoma presents a unique set of challenges, including a scarcity of available data, which limits evidence-based recommendations. Nearly half of patients with a new diagnosis of glioblastoma are over 65 years of age, a common cutoff point in the medical literature for identifying an elderly population. The current standard of care for glioblastoma patients younger than 70 years of age with satisfactory performance status is maximal safe resection, followed by radiation therapy of 60 Gy (delivered in 30 fractions over a 6-week period) with concurrent temozolomide chemotherapy, followed by adjuvant temozolomide. There is no consensus recommendation regarding the best available treatment for patients over age 70 with glioblastoma; however, multiple studies have shown molecular characterization of glioblastoma in this group-particularly MGMT promoter methylation status-to be valuable in treatment decision making. Results of the phase III CE6 study by the Canadian Cancer Trials Group challenge the existing treatment paradigms for glioblastoma in the elderly. This review discusses best practices for the treatment of glioblastoma in patients older than 65 years, and highlights management concerns in caring for this particular patient population.