In recent years, the incidence of glioma, like other tumors in the body, has been increasing year by year, and is more prominent in the elderly population. According to the international standard, people aged 65 years and above are collectively referred to as the elderly, and epidemiological surveys in Europe and the United States show that low-grade gliomas occur mainly in young adults, while high-grade malignant gliomas occur mainly in the elderly. Studies in the United States have shown that about half of all glioblastomas occur in the elderly, and it is believed that almost all gliomas in the elderly are high-grade, i.e., highly malignant, while the possibility of low-grade gliomas is almost nonexistent. However, in my years of clinical work, I have encountered some elderly people with low-grade gliomas, but it is true that the incidence is lower compared to young adults, and this may also be related to ethnicity.
Studies have now confirmed that in malignant gliomas, age is an important factor affecting prognosis, that is, the prognosis is worse in the elderly than in young adults, and the older the elderly are, the worse the prognosis will be. In addition, the patient’s quality of life before treatment is also an important factor in prognosis. It is generally believed that patients with a Karnofsky quality of life score of less than 70, i.e., those who require care from others, have a worse prognosis. The median survival of glioblastoma patients is generally considered to be 9-14 months, but statistics from the United States show that the median survival of glioblastoma in the elderly is only about 6 months. The following information is the statistics of American experts on the survival of glioblastoma patients in different age groups, from which we really feel the threatening level of this tumor, but will also show us the miracle of life and hope.
Survival of glioblastoma patients in different age groups.
Age (years)
Number of patients
One year (%)
Two years (%)
Five years (%)
Ten years (%)
0-19
244
51
28.8
19.3
16.4
20-44
1643
58.9
29.8
13.4
8.4
45-64
5872
34.8
7.8
2.1
1.0
>64
5974
13.3
2.1
0.3
0.2
Although most of the current international clinical trials exclude the elderly, I have gradually summarized a set of treatment strategies for malignant glioma in the elderly by summarizing the results of many years of research and clinical experience and referring to the advanced international theories and views, which are shared below with the majority of colleagues and interested parties.
First, surgical resection of tumor remains the first choice of glioma treatment for elderly patients. Surgery has been shown to relieve neurological symptoms and prolong survival in elderly patients with malignant glioma, and is an independent factor in achieving a better prognosis for patients.
However, it is important to note that in elderly patients, in addition to assessing the general imaging manifestations of malignant glioma and the risks of surgery, a thorough analysis of the patient’s quality of life and physical condition, especially the function of the heart, liver, lungs and kidneys, as well as the severity of systemic diseases such as hypertension and diabetes mellitus, is required. For elderly patients who can take care of themselves and do not have serious organic diseases, it is estimated that the patient can tolerate general anesthesia and general craniotomy blows, and the incidence of postoperative hemiparesis is estimated to be low, surgery is completely possible, and age is not an absolute factor in deciding whether to operate. In my personal work experience, the highest age of operated patients reached 78 years.
Surgery in the elderly requires attention: the operation should be expedited and the operative time should be minimized, which will reduce the damage to the patient due to prolonged anesthesia and surgical exposure. In addition, monitoring and care should be strengthened after surgery to encourage early bedtime activities because surgical strikes are likely to cause elevated blood glucose, elevated blood pressure, pulmonary infections, and deep vein thrombosis in the lower extremities in elderly patients, especially deep vein thrombosis is highly prone to fatal pulmonary embolism.
Second, radiotherapy is another important option for the treatment of malignant glioma in elderly patients. Studies have confirmed that radiotherapy can prolong the survival of elderly patients with less impact on cognitive function and quality of life, and it has now become the standard treatment for patients, and the effect will be better if used in conjunction with surgery, which can prolong the median survival by 6-10 months. However, in practice, the dose and duration of radiotherapy should also be appropriately adjusted according to the lesion and the patient’s physical condition to minimize the side effects of radiotherapy.
Third, chemotherapy is also an important option for the treatment of malignant glioma in elderly patients, especially the emergence of temozolomide chemotherapy drug, which brings new options for the treatment of glioma in elderly patients. Due to the good efficacy and safety of this drug, especially the accumulative toxic effects on bone marrow, it has now become the first-line chemotherapy drug for the treatment of elderly patients with malignant glioma. Data show that the median survival for temozolomide monotherapy is 6.4 months. However, in patients over 70 years of age, close attention should be paid to the patient’s blood tests. In the patients I treated, the decline in white blood cells and/or platelets occurred mainly in patients over 70 years of age.
Fourth, the adjuvant regimen of temozolomide continued after concurrent radiotherapy is also a reasonable and tolerable treatment for elderly patients with malignant glioma in good health. Data show that adjuvant concurrent radiotherapy regimens after surgery can result in a median survival of 9.3-13.7 months.
V. Palliative care is the last option for elderly patients with malignant glioma. For patients with deep tumor location, estimated high risk of surgery, or poor health condition and serious physical diseases such as heart disease and diabetes, nutritional support and spiritual comfort may have to be the main treatment components if surgery, radiotherapy and chemotherapy are not possible. In such cases, my advice is to first minimize the patient’s pain, secondly to provide spiritual and psychological comfort, and thirdly to enhance nutrition and care to minimize the occurrence of pulmonary infections, venous thrombosis and decubitus ulcers.
In conclusion, for elderly patients with malignant glioma, surgery + radiotherapy + chemotherapy is still the main treatment strategy when all conditions allow, and treatment should not be given up easily because of older age, because although the overall treatment effect of malignant glioma is not yet ideal, the possibility of miracles cannot be ruled out, and giving up treatment is the same as giving up all hope. In general, patients who do not receive these treatments, even with the best nutritional support, have a median survival of about 4 months.