Beyond Chronological Age: Integrating Geriatric Assessment, Surgical Decision-Making, and Personalized Oncological Treatment in Glioblastoma

Glioblastoma represents one of the most aggressive primary malignant tumors of the central nervous system, presenting substantial therapeutic challenges in older adults due to the interaction between tumor progression, physiological vulnerability, comorbidities, and functional deterioration. This narrative review aimed to analyze the role of comprehensive geriatric assessment, extent of surgical resection, and individualized oncological strategies in patients aged 65 years and older. A structured descriptive and comparative analysis was conducted using 20 scientific publications, including randomized clinical trials, observational studies, meta-analyses, and international clinical recommendations, with particular consideration of Latin American contributions. The reviewed evidence indicated that surgical resection was associated with improved overall survival compared with biopsy, with a pooled mean difference of 6.13 months, although postoperative complications were more frequent following resection. Hypofractionated radiotherapy demonstrated clinically relevant survival outcomes in older populations, while the addition of temozolomide to short-course radiotherapy increased median overall survival from 7.6 to 9.3 months and progression-free survival from 3.9 to 5.3 months. MGMT promoter methylation emerged as an important predictive biomarker for chemotherapy benefit, supporting molecularly informed therapeutic selection. However, differences in frailty, cognitive function, neurological performance, and treatment tolerance remain essential considerations. The available evidence also revealed limitations regarding standardized geriatric assessment, postoperative functional outcomes, and the representation of Latin American populations in prospective research. Overall, individualized management integrating geriatric vulnerability, surgical feasibility, molecular characteristics, and patient-centered priorities provides a clinically relevant framework for therapeutic decision-making. Further prospective investigations are necessary to validate multidimensional treatment algorithms and improve survival while preserving neurological function, autonomy, and quality of life.