Introduction
Glioblastoma, a highly aggressive and often incurable form of primary brain cancer, represents a formidable challenge in the field of oncology. While this devastating disease primarily affects older adults, the complexities surrounding its diagnosis and management present unique hurdles that demand careful consideration. The dismal prognosis of glioblastoma is demonstrated by a five-year survival rate of fewer than 10 percent and a median overall survival of less than 15 months, even with treatment. Furthermore, the majority of this burden falls on older persons, with a peak incidence in those 65 and older. There is optimism and new prospects for older glioblastoma patients as a result of recent research initiatives that have started to alter treatment tactics.
What Is Glioblastoma and Its Clinical Manifestation in Older Adults?
Glioblastoma, or glioblastoma multiforme, is an aggressive and incurable primary brain cancer that primarily affects older individuals. It is the most common and malignant form of brain cancer, characterized by its rapid growth, invasive nature, and high resistance to treatment. The brain's glial cells, which support and uphold the function of the brain, play a major role in the development of glioblastoma.
Glioblastoma patients usually reach its peak occurrence when they are 65 years of age or older. In this case, advanced age is more than simply a number; it significantly affects how the illness progresses. Older patients with glioblastoma often have a lower prognosis, with a median survival of about six months. There are several things that specifically impact older persons that could be the cause of this reduced survival.
Clinical Manifestation:
Glioblastoma can appear with a variety of challenging clinical symptoms in elderly patients.
1. Neurological Symptoms: Neurological symptoms such as excruciating headaches, convulsions (sudden, uncontrolled muscle contractions or spasms, often accompanied by jerking movements and loss of consciousness), memory loss, and behavioral and personality changes are frequently experienced by patients. Hemiparesis, or weakness on one side of the body, combined with poor coordination, makes it difficult to do daily tasks like dressing and walking.
2. Cognitive Impairment: It is a common problem that affects a patient's quality of life greatly by causing memory loss, concentration difficulties, and mental status changes. Furthermore, older people may have more trouble with speech issues like slurred speech and vision issues like double or blurred vision. Frequent focal seizures (arise from a particular region of the brain and may cause a range of localized symptoms or an altered consciousness) may require the use of anti-epileptic drugs.
3. Behavioral Changes: Including mood swings, depression, or apathy adds complexity to the clinical picture. Generalized weakness and fatigue further impair functional independence, necessitating greater care and support. Notably, a high number of elderly individuals with glioblastoma manage numerous drugs and extra medical comorbidities, which increases the likelihood of therapy-related problems and complicates treatment decisions.
What Are the Treatment Strategies for Glioblastoma in Older Adults?
In the past, older people with glioblastoma have had significantly different therapy options than younger patients with the same disease. Older patients frequently got less vigorous therapy because of worries about the dangers associated with treatment-related toxicities and a lack of agreement over a standard of care. This vulnerable demographic was typically left out of practice-defining investigations and clinical trials.
A. Recent Advances and Patient-Centered Approach
The strategy used to treat elderly glioblastoma patients has seen a significant change in the last several years. Numerous randomized controlled trials (RCTs) tailored to the senior population have been produced as a result of efforts to identify best practices for these individuals. For older patients with good performance status, the most recent RCT provided important data in favor of a particular treatment plan that combines chemotherapy and hypofractionated radiation (involves delivering fewer but larger doses of radiation during cancer treatment, which can help reduce the overall treatment duration). This is a significant advancement in the treatment of glioblastoma in older people.
1. Surgical Resection
An important part of glioblastoma treatment is surgical resection. The amount of surgical resection is a crucial prognostic determinant, even though total removal of glioblastoma is sometimes unattainable because of its infiltrative nature. Even in elderly individuals, higher resection is linked to better overall survival rates.
However, there are challenges associated with surgical resection in older adults. The risk of surgical complications is higher in this population, emphasizing the importance of careful patient selection.
2. Radiation Therapy
An important aspect of treating glioblastoma is radiation therapy. It frequently comes in combination with Temozolomide (TMZ), a chemotherapy medication. When treating younger patients, doctors typically combine TMZ with regular radiation therapy administered over several weeks.
Studies have shown, however, that a shorter radiation course, known as hypofractionated radiation, may be safer and equally effective for elderly people. In other words, a shorter, more focused radiation treatment can provide the same advantages for elderly individuals.
In a significant study, postoperative radiation therapy for elderly patients (over 70 years of age) resulted in a longer survival rate compared with supportive care alone. The good news is that their general quality of life did not worsen as a result of this radiation therapy. Therefore, in order to help elderly patients undergo radiation therapy more easily while still receiving the same benefits, doctors are increasingly employing shorter radiation courses.
3. Temozolomide (TMZ) and Systemic Therapies
One popular chemotherapeutic medication for glioblastoma is Temozolomide (TMZ). It is typically the first option for medical care. However, elderly patients may think about using TMZ alone if they are unable to tolerate radiation and chemotherapy combination. Some have demonstrated benefit from it.
In one trial, individuals over 70 who used TMZ lived longer than those who had radiation therapy alone. In elderly patients, TMZ produced comparable outcomes to standard radiation therapy, according to another study. The intriguing element is that the effectiveness of TMZ may be influenced by a certain gene marker known as MGMT (O-6-methylguanine-DNA methyltransferase).
Combining multiple chemotherapeutic medications, such as TMZ and CCNU (Lomustine), is promising in certain situations, particularly for younger patients. To be sure, though, additional research needs to be conducted.
4. Concurrent Chemo-Radiation
For many years, the typical post-operative care for younger patients with glioblastoma involved administering both chemotherapy and radiation therapy. There were actual advantages. However, older patients did not benefit as much from this combined treatment, particularly those between 60 and 70.
More evidence about the potential benefits of this combined treatment for older individuals is provided by recent research. In these researches, the survival rates of older individuals with glioblastoma were higher when they received both chemotherapy and radiation therapy over a brief course of treatment.
Why Are Older Adults More Susceptible to Treatment Toxicities in Glioblastoma Management?
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Comorbidities and Polypharmacy: Elderly patients frequently have more medical conditions than they used to, and they frequently take several medications (polypharmacy). The treatment of glioblastoma may become more difficult if certain pre-existing illnesses and drugs are taken.
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Social Situations: Living in unstable social environments with little social support is more common among older persons. Having a solid support network is essential for overcoming glioblastoma's obstacles throughout treatment.
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Reduced Functional and Cognitive Reserve: With age, there is a natural decline in functional and cognitive abilities. Glioblastoma and its treatments can further compromise these capacities.
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Treatment Toxicities: Treatment-related side effects, such as radiation therapy, chemotherapy, and surgery, can be especially problematic for older persons.
What Are the Future Directions in Glioblastoma Treatment for Older Adults?
New studies and clinical trials are transforming the way that glioblastoma is treated in the elderly. Continuous searching is necessary to find more effective ways to care for senior patients in the future, particularly those who are not in good condition. Additionally, novel medicines, including immunotherapy and targeted therapies designed specifically for the elderly, are under investigation. More research is needed to determine the best ways to treat glioblastoma when it recurs, and older patients with this type of cancer may benefit from high-tech surgeries and cancer treatments like Tumor Treating Fields (TTF), which uses electric fields to stop cancer cells from proliferating. Glioblastoma patients who are older will benefit from this.
Conclusion
To summarize, glioblastoma presents a significant difficulty, especially in older persons who have severe health and performance issues. Even though knowledge and treatment of this aggressive brain cancer have advanced significantly, considerable effort has to be made to improve care for elderly people. Individualized chemotherapy dosages and shorter radiation therapy regimens are two examples of targeted treatment strategies that hold promise for preserving survival and quality of life. To improve outcomes for this vulnerable patient population, particularly in the case of recurrent glioblastoma, further research is imperative to investigate novel treatments and intervention measures.
