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. 2018 Jul;91(1088):20170271.
doi: 10.1259/bjr.20170271. Epub 2018 Mar 9.

Management of elderly patients with glioblastoma-multiforme-a systematic review

Affiliations

Management of elderly patients with glioblastoma-multiforme-a systematic review

Almadani Asmaa et al. Br J Radiol. 2018 Jul.

Abstract

The management of elderly patients with glioblastoma-multiforme (GBM) remains poorly defined with many experts in the past advocating best supportive care, in view of limited evidence on efficacy of more aggressive treatment protocols. There is randomised evidence (NORDIC and NA-O8 studies) to support the use of surgery followed by adjuvant monotherapy with either radiotherapy (RT) using hypofractionated regimes (e.g. 36 Gy in 6 fractions OR 40 Gy in 15 fractions) or chemotherapy with temozolomide (TMZ) in patients expressing methylation of promoter for O6-methylguanine-DNA methyltransferase enzyme. However, the role of combined-modality therapy involving the use of combined RT and TMZ protocols has remained controversial with data from the EORTC (European Organisation for Research and Treatment of Cancer)-NCIC (National Cancer Institute of Canada) studies indicating that patients more than 65 years of age may not benefit significantly from combining standard RT fractionation using 60 Gy in 30 fractions with concurrent and adjuvant TMZ. More recently, randomised data has emerged on combining hypofractionated RT with concurrent and adjuvant TMZ. We provide a comprehensive review of literature with the aim of defining an evidence-based algorithm for management of elderly glioblastoma-multiforme population.

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Figures

Figure 1.
Figure 1.
Schematic illustration of the search strategy and the nature of the studies selected for discussion in the review. RCT, randomized controlled trial ; RT, radiotherapy; TMZ, temozolomide.
Figure 2.
Figure 2.
Evolving treatment algorithm for management of elderly patients with GBM. HRT, hypofractionated RT; KPS, Karnofsky performance status; RT, radiotherapy; TMZ, temozolomide; SRT, standard radiotherapy.

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