The treatment for elderly patients affected by glioblastoma represents a challenge in neuro-oncology. The recent randomized trials (the NOA-8 and the NCBTSG trials) showed an advantage of temozolomide for patients with O6-methylguanine methyltransferase methylated tumors. To date, no randomized trials compared the standard treatment (radiochemotherapy) with other therapeutic approaches, due to the idea that elderly patients do not tolerate aggressive therapy. Nonetheless, with the increased lifespan and the better quality of life, the nihilism in the treatment of elderly with cancer is obsolete. Molecular (including O6-methylguanine methyltransferase) and clinical tools (including the geriatric evaluation) are needed for choosing the proper therapy for patients over 70.