Glioblastoma

Glioblastoma is the most common and most aggressive primary malignant brain tumor in adults. The median age at diagnosis is 64 with a peak incidence in the 75–84 age range. Because glioblastoma is commonly a diagnosis of older patients, many with compromised performance status, balancing the therapeutic benefit with toxicity and quality of life is an especially important consideration. Hypofractionated radiotherapy (RT) has an important role in the treatment of many patients with glioblastoma with best data supporting its use in the older population. Patients older than 65–70 with good performance status are candidates for hypofractionated RT ± concurrent and adjuvant temozolomide. Patients with poor performance status can be considered for hypofractionated RT alone, temozolomide alone, or palliative/best supportive care based on MGMT methylation status and overall clinical picture.