Service de neurologie Mazarin, Hôpital Pitié-Salpêtrière, Paris, France
Incidence of malignant gliomas is growing in the elderly population. Unfortunately, increasing age is one of the most important negative prognostic factors in gliomas. However, the previous nihilistic approach is progressively changing towards more active strategies. Particularly, prospective randomized studies have recently established the benefit of radiotherapy associated with concomitant and adjuvant chemotherapy by temozolomide in older patients with good functional status suffering from malignant gliomas. Chemotherapy alone may even be useful in this population, especially in patients with poor functional status. Symptomatic treatments such as corticosteroids and antiepileptic drugs may be less tolerated in this population compared to younger patients and should be used only if needed. Initial performance status, quality of life and concomitant pathologies are obviously important factors to consider before treatment onset. The willingness of the patient and his caregivers will also be the key of the therapeutic decision. In the future, it will be necessary to develop specific schedules of treatment in this population. For this reason, prospective randomized clinical trials are needed to improve the pattern of care of malignant glioma in the elderly.