Glioblastoma therapy in the elderly: one age does not fit all
Mené sur 342 patients âgés de 60 ans ou plus et atteints d'un glioblastome, cet essai de phase III compare, du point de vue de la survie globale, les effets du temozolomide, d'une radiothérapie hypofractionnée et d'une radiothérapie standard
The incidence of glioblastoma rises with increasing age, and peaks in the age group 75—84 years. The median age at diagnosis of glioblastoma is currently 64 years, but as life expectancy lengthens and the population ages this age is set to rise. Age has consistently been the most important prognostic factor in glioblastoma: in patients who receive the standard of care, median survival decreases with each increasing decade of life beyond 50 years. Among characteristics that might affect how oncologists make treatment decisions for elderly patients with glioblastoma are age, shortening of life span, tumour biology, extent of resection, comorbidities, functional status and reserve, and access to care and caregivers. Additionally, different countries might have specific health-care constraints that affect decision making. Indeed, even though clinical investigations are beginning to define appropriate care for elderly patients with glioblastoma, there is a view in neuro-oncology, albeit poorly supported by data, that age must be taken into account during selection of treatment. Randomised studies of elderly patients have generally enrolled low-functioning populations and have focused on minimising intervention, whereas higher-functioning populations have mostly been assessed in single-arm studies. Integration of the findings into the clinical setting has, therefore, been difficult...
The Lancet Oncology , commentaire en libre accès, 2011