Service de neurologie Mazarin, hôpital de la Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France.
Service de gériatrie hôpital de la Pitié-Salpêtrière, AP-HP, 75651 Paris cedex 13, France.
Rev Neurol (Paris). 2020 Nov;176(9):724-732. doi: 10.1016/j.neurol.2020.01.362. Epub 2020 Apr 16.
Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults. The incidence of malignant gliomas is growing in the elderly population. Unfortunately, increasing age is one of the most important negative prognostic factors for this tumor. For a long time, the treatment of elderly patients with GBM was controversial. Currently, more active strategies are the rule. Indeed, as in the younger population, prospective randomized studies have recently established the benefit of radiotherapy associated with concomitant and adjuvant chemotherapy by temozolomide in older patients suffering from malignant gliomas with good functional status. The application of chemotherapy alone may be especially useful in patients with poor functional status and O-6-methylguanine-DNA methyltransferase (MGMT) promotor methylation. For the portion of the elderly population identified as frail, treatment decisions should be made in the context of a comprehensive geriatric evaluation while also taking into account quality of life and concomitant pathologies. The willingness of the patient and his or her caregivers will also be key to the therapeutic decision. Symptomatic treatments such as corticosteroids and antiepileptic drugs may be less tolerated in this population compared to younger patients and should be used only if requested. In the future, it will be necessary to continue to develop specific schedules of treatment in the frail population. For this reason, prospective randomized clinical trials are still needed to pursue improvements in the pattern of care of malignant glioma in elderly individuals.
多形性胶质母细胞瘤（GBM）是成人中最常见的原发性脑肿瘤。恶性胶质瘤在老年人群中的发病率正在增加。不幸的是，年龄增长是该肿瘤最重要的预后不良因素之一。长期以来，老年 GBM 患者的治疗一直存在争议。目前，更积极的治疗策略是主流。实际上，与年轻人群一样，最近的前瞻性随机研究已经证实，对于功能状态良好的患有恶性胶质瘤的老年患者，放疗联合替莫唑胺同期和辅助化疗具有获益。对于功能状态较差且 O-6-甲基鸟嘌呤-DNA 甲基转移酶（MGMT）启动子甲基化的患者，单独应用化疗可能特别有用。对于被确定为体弱的老年人群，应在全面老年评估的背景下做出治疗决策，同时考虑生活质量和并存的病理情况。患者及其护理人员的意愿也将是治疗决策的关键。与年轻患者相比，这类人群对皮质类固醇和抗癫痫药物等对症治疗的耐受性可能较差，只有在有需求时才应使用。未来，有必要继续为体弱人群制定具体的治疗方案。出于这个原因，仍然需要前瞻性随机临床试验来进一步改善老年人群中恶性胶质瘤的治疗模式。
