Primary brain tumors in the elderly population.

OPINION STATEMENT: Elderly cancer patients are an important challenge in oncology, and clinical data from younger populations cannot be automatically considered applicable to unselected elderly patients with brain tumors, who tend to have more comorbidities and tolerate chemotherapy and radiotherapy less well than their younger counterparts. Most data available on elderly cancer patients are from retrospective studies that do not include age-specific enrollment criteria and are biased by intrinsic selection criteria governing enrollment. Most clinicians are unwilling to enroll elderly patients because of ageism and a fear of toxicity and poor outcome. Specifically designed trials based on genetic features and clinical factors are required to clearly establish the standard of care required for elderly patients with brain tumors, especially those with glioblastoma. Currently, surgery followed by radiotherapy is widely used for elderly glioblastoma patients, but temozolomide is the chemotherapeutic approach of choice for those with a relatively good clinical condition and prognosis. However, the schedule to follow and the best dosage have yet to be satisfactorily established.