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Although the median age at diagnosis of glioblastoma is currently 64 years, so far no study has provided clear guidance on the optimum treatment for elderly patients with glioblastoma. In fact, when the combination of radiotherapy and chemotherapy with the alkylating agent temozolomide became the standard of care in 2004, increasing age was found to be a negative prognostic factor. As a consequence, treatment with this combination was not justifiable in the more elderly and frailer patients.

In search for some treatment recommendations for patients with glioblastoma who were ≥60 years old, the Nordic Clinical Brain Tumour Study Group wondered whether short treatment times with temozolomide or hypofractionated radiotherapy would be beneficial for this group of patients.

To this end, they designed a randomized trial in which they assessed chemotherapy with the single agent temozolomide (200 mg/m2 for 5 days every 28 days for up to six cycles) in 119 patients, hypofractionated radiotherapy (34.0 Gy delivered in 10 fractions of 3.4 Gy 5 days/week for 2 weeks) in 123 patients, and standard radiotherapy (60.0 Gy administered in 30 fractions of 2.0 Gy 5 days/week for 6 weeks) in 100 patients. The average age of the patients was 70 years in all treatment groups.

When compared with standard radiotherapy, overall survival—the primary end point—was significantly improved in patients receiving temozolomide (8.3 months and 6.0 months), but not in patients receiving hypofractionated radiotherapy (7.4 months). Importantly, although survival did not differ between treatments for patients aged 60–70 years, for patients older than 70 years, survival was better with temozolomide and with hypofractionated radiotherapy than with standard radiotherapy.

According to Jay Loeffler, Chief of the Radiation Oncology Department in the Masssachussets General Hospital “this study indicates [that] for elderly patients, temozolomide alone is a reasonable first treatment option especially if the radiation target volume would be significant.” In line with the authors' observations, he then makes an important remark: “for patients [aged] 60–70, the standard of care is still radiation and concurrent and adjuvant temozolomide; this was not one of the treatment options, so for these patients in this age group, this will not change current practice.”

These data suggest that elderly patients do benefit from antitumour therapy, and that temozolomide or hypofractionated radiotherapy might be valid alternatives to standard chemoradiotherapy.