Brain gliomas in the elderly

Abstract

The incidence of gliomas, especially of glioblastomas, has risen in the elderly population. Due to their dismal prognosis and the fear that they may not tolerate brain radiotherapy and chemotherapy, elderly patients with gliomas have long been undertreated. Within the last decade, however, the management of elderly patients with gliomas has improved. In glioblastomas several clinical trials have now demonstrated that radiotherapy, temozolomide chemotherapy and temozolomide radiochemotherapy can increase overall survival without impairing quality of life, even in patients with poor performance status. As in younger patients, molecular biology, especially MGMT promoter methylation status, is playing an increasing role in treatment decisions. Nevertheless, the prognosis of glioblastomas in the elderly remains very poor, and further studies are needed to improve patients’ care. In younger patients, important progress has been made in the understanding and treatment of lower-grade gliomas. It remains to be determined how these advances apply to the relatively rare cases of lower-grade gliomas in elderly patients. Herein, we summarize the main clinical, radiological histological and molecular features of gliomas in elderly patients and review the different therapeutic options.