This protocol addresses newly diagnosed glioblastoma in patients older than 70 years who retain good functional status and whose tumour carries MGMT promoter methylation. Age, functional reserve, and MGMT status together shape the treatment decisions for this specific population.
Treatment decisions after maximal safe resection depend on age, functional status, MGMT status, and patient care goals. In patients older than 70 years with preserved performance status, the management approach shares similarities with that for younger patients, while also reflecting regimens adapted to this age group. MGMT promoter methylation is a key determinant of which options are most appropriate.
Given the modest benefits of standard treatments, participation in clinical trials is highly recommended for patients with good performance status of any age.
When available, enrolment in a clinical trial is the preferred first step for patients in this group. Outside of a trial, radiotherapy-based regimens — tailored to age and MGMT methylation status — form the basis of care. The full protocol details the available options and the criteria that guide selection among them.
Treatment decisions for glioblastoma after maximal safe resection depend on age, functional status, MGMT status, and patient care goals (Figure 8).
Given the modest benefits of standard treatments, participation in clinical trials is highly recommended for patients with good performance status of any age.
Treatment is similar to the approach for younger patients and includes maximal safe surgical resection, radiotherapy and temozolomide, although randomized studies failed to show a survival difference between biopsied and resected patients.
Treatment regimens for newly diagnosed glioblastoma patients older than 65–70 years involve standard radiochemotherapy but shortened regimens for frailer patients may include hypofractionated radiation (eg, 40 Gy in 15 fractions) with temozolomide, hypofractionated radiation alone for patients with MGMT unmethylated glioblastoma, or temozolomide alone for patients with MGMT methylated glioblastoma.
DOI: 10.1093/neuonc/noaf177
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