Neuro-Oncology in the Elderly

Abstract

Abstract This chapter covers the main aspects of management of glioblastomas, low-grade gliomas, and primary central nervous system (CNS) lymphomas in the elderly. An extensive use of available geriatric scales is recommended to distinguish fit versus unfit patients before deciding any treatment. In the case of fit patients with high-grade glioma, surgical resection as complete as possible followed by radiotherapy and concomitant/adjuvant temozolomide is the standard of care. In the case of unfit patients with high-grade glioma, biopsy followed either by hypofractionated radiotherapy in case of O6-methylguanine DNA methyltransferase (MGMT) unmethylated tumors or temozolomide in case of MGMT methylated tumors should be proposed. Supportive care should be reserved to patients with low performance status or high burden of comorbidities. Low-grade gliomas in elderly patients are rare and should be treated with surgery, radiotherapy, and adjuvant temozolomide when appropriate. Primary CNS lymphomas following biopsy should receive an up-front methotrexate-based regimen. In case of a complete response to chemotherapy whole brain-radiation therapy should be reserved at tumor progression to delay neurocognitive deterioration.