Elsevier

European Journal of Cancer

Volume 51, Issue 15, October 2015, Pages 2231-2241
European Journal of Cancer

Survival of adults with primary malignant brain tumours in Europe; Results of the EUROCARE-5 study

https://doi.org/10.1016/j.ejca.2015.07.032Get rights and content

Abstract

Background

Primary malignant brain tumours are rare but represent a serious health burden due to their poor survival. This manuscript describes the survival of malignant brain tumours in adults diagnosed 2000–2007 in Europe.

Methods

For this study we analysed patients archived in 86 European population-based cancer registries, followed up to 31st December 2008. Only primary malignant neuroepithelial brain tumours (with pathological confirmation) and primary malignant unspecified brain tumours without pathological confirmation were included. We estimated 1-year and 5-year relative survival (RS) weighted by age group and country. We also estimated country-specific and age-specific survival, together with survival differences between time periods (for 1999–2001, 2002–2004 and 2005–2007).

Results

Glioblastoma represents 49% of all brain tumours, followed by other/unspecified astrocytoma (18%), oligodendroglioma/oligoastrocytoma (9%), ependymoma (1.5%) and embryonal tumours (1%). Five-year RS was 20% for all tumours combined, but ranged from 58% for ependymoma to only 6% for glioblastoma and sharply decreased with increasing age.

Differences between countries were relatively small, but generally RS in Ireland/United Kingdom (UK) and Eastern Europe was below the average. An increase in 1-year RS (up to 10–12%) was noted over time, being largest in Central and Northern Europe in patients between 45 and 74 years of age.

Conclusions

Despite an increase in 1-year RS in most European regions, the survival of primary malignant brain tumours is still poor. Disparities between countries were evident, being even larger at the end of the study period than at the beginning, suggesting differences in availability of the latest treatment modalities.

Introduction

Tumours of the central nervous system (CNS) represent a relatively rare but serious health burden. In 2012, 57,000 new diagnoses of and 45,000 deaths for tumours of the brain and other parts of the CNS were estimated in Europe [1], [2]. CNS tumours occur at all ages: the malignant CNS tumours account for 16% of all childhood cancers combined [3], and 1–3% of all cancers, depending on the inclusion/exclusion of benign tumours [1], [4].

CNS tumours are classified into diagnostic categories [5], each with distinct pathological, epidemiological and prognostic characteristics. They are also subdivided into grade I–IV according to the World Health Organisation (WHO) grading system [5]. A strong correlation between grade and prognosis exists, with grade I having the most favourable and grade IV the poorest prognosis. Glioblastoma corresponds to WHO grade IV with a median survival <6 months [6]. As glioblastoma is the most frequent primary brain tumour, the overall prognosis of CNS tumours is very poor [7].

Treatment for CNS tumours mainly consists of surgical resection and, for high grade tumours, adjuvant radiotherapy. After having demonstrated an increase in the median survival in a clinical trial setting by 2.5 months [8], or 4.6 months in those having undergone complete resection [9], the alkylating agent temozolomide was added to the therapeutic arsenal against glioma.

Since survival comparisons for CNS tumours are hampered by differences in inclusion criteria or morphology subgroups distribution, the present paper describes survival for malignant neuroepithelial brain tumours across Europe and overtime, according to age and histology, in the context of the EUROCARE-5 study.

Section snippets

Materials and methods

Unique and multiple malignant (International Classification of Diseases for Oncology, 3rd revision [ICD-O-3] behaviour code/3 [10]) brain tumours (ICD-O-3 topography code C71), diagnosed up to the end of 2007 and followed up until December 2008 were considered. Eighty-six European cancer registries (CRs) in 28 countries divided into five European regions (Ireland/United Kingdom [UK], Northern, Central, Southern and Eastern Europe) could contribute to the analyses.

In order to minimise the effect

Results

A total of 83,458 malignant primary neuroepithelial brain tumours were analysed, of which 31% were archived in England, 11% in Germany and 9% in the Netherlands (Table 1). The proportion of MV cases showed a large variation between countries ranging from 61% (Scotland) to 100% (Poland).

About half of cases were glioblastoma, followed by other astrocytoma (19%), oligodendroglioma (9%), ependymoma (2%) and embryonal tumours (1%) (Supplementary Table 2). Eight percent of all cases were classified

Discussion

The present population-based study on survival for malignant neuroepithelial brain tumours included data from 24 European countries. The average 5-year RS in 2000–2007 was 20%, but below 10% for patients 65 years or older. Like in earlier EUROCARE studies we found disparities between countries. A small increase in 5-year RS was observed, being slightly larger in Northern, Central and Southern Europe than in Eastern Europe and Ireland/UK. A more pronounced increase up to 12 percentage points was

Role of funding source

The study was funded by the Compagnia di San Paolo, the Fondazione Cariplo Italy, the Italian Ministry of Health (Ricerca Finalizzata 2009, RF-2009-1529710) and the European Commission (European Action Against Cancer, EPAAC, Joint Action No. 20102202). The funding sources had no role in study design, the collection, analysis or interpretation of data, the writing of the report, or the decision to submit the article for publication.

Conflict of interest statement

None declared.

Acknowledgements

We thank Chiara Margutti, Simone Bonfarnuzzo and Camilla Amati for secretarial assistance.

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