Malignant gliomas in older adults with poor prognostic signs. Getting nowhere, and taking a long time to do it.

The median survival time of adults with supratentorial malignant glioma treated in clinical studies with surgery, 6 weeks of external-beam radiotherapy, and carmustine (BiCNU) is approximately 1 year. This poor survival time is almost certainly optimistic, since only a select subgroup of patients end up participating in clinical trials--ie, those with a better prognosis. For elderly patients and/or those with poor functional status, median survival time ranges from 16 to 40 weeks. A regimen of surgery plus 2 to 3 weeks of radiotherapy appears to achieve a survival duration equivalent to that of long courses of chemoradiotherapy at less cost in time and money, and perhaps with less caregiver stress. Since the incidence of brain tumors in the elderly is rising and the size of the elderly population is increasing, it is appropriate to investigate the role of less aggressive therapy for what will be a growing number of malignant glioma patients with a poor prognosis.